CASE I
Philiscus lived by the wall. He took to his bed with acute fever on the first day and sweating ; night uncomfortable.
Second day. General exacerbation, later a small clyster moved the bowels well. A restful night.
Third day. Early and until mid-day he appeared to have lost the fever ; but towards evening acute fever with sweating ; thirst ; dry tongue ; black urine. An uncomfortable night, without sleep ; completely out of his mind.
Fourth day. All symptoms exacerbated ; black urine ; a more comfortable night, and urine of a better colour.
Fifth day. About mid-day slight epistaxis of unmixed blood. Urine varied, with scattered, round particles suspended in it, resembling semen ; they did not settle. On the application of a suppository the patient passed, with flatulence, scanty excreta. A distressing night, snatches of sleep, irrational talk ; extremities everywhere cold, and would not get warm again ; black urine ; snatches of sleep towards dawn ; speechless ; cold sweat ; extremities livid. About mid-day on the sixth day the patient died. The breathing throughout, as though he were recollecting to do it, was rare and large. Spleen raised in a round swelling ; cold sweats all the time. The exacerbations on even days.
CASE II
Silenus lived on Broadway near the place of Eualcidas. After over-exertion, drinking, and exercises at the wrong time he was attacked by fever. He began by having pains in the loins, with heaviness in the head and tightness of the neck. From the bowels on the first day there passed copious discharges of bilious matter, unmixed, frothy, and highly coloured. Urine black, with a black sediment ; thirst ; tongue dry ; no sleep at night.
Second day. Acute fever, stools more copious, thinner, frothy ; urine black ; uncomfortable night ; slightly out of his mind.
Third day. General exacerbation ; oblong tightness of the hypochondrium, soft underneath, extending on both sides to the navel ; stools thin, blackish ; urine turbid, blackish ; no sleep at night ; much rambling, laughter, singing ; no power of restraining himself.
Fourth day. Same symptoms.
Fifth day. Stools unmixed, bilious, smooth, greasy ; urine thin, transparent ; lucid intervals.
Sixth day. Slight sweats about the head ; extremities cold and livid ; much tossing ; nothing passed from the bowels ; urine suppressed ; acute fever.
Seventh day. Speechless ; extremities would no longer get warm ; no urine.
Eighth day. Cold sweat all over ; red spots with sweat, round, small like acne, which persisted without subsiding. From the bowels with slight stimulus there came a copious discharge of solid stools, thin, as it were unconcocted, painful. Urine painful and irritating. Extremities grow a little warmer ; fitful sleep ; coma ; speechlessness ; thin, transparent urine.
Ninth day. Same symptoms.
Tenth day. Took no drink ; coma ; fitful sleep. Discharges from the bowels similar ; had a copious discharge of thickish urine, which on standing left a farinaceous, white deposit ; extremities again cold.
Eleventh day. Death.
From the beginning the breath in this case was throughout rare and large. Continuous throbbing of the hypochondrium ; age about twenty years.
CASE III
Herophon had acute fever ; scanty stools with tenesmus at the beginning, afterwards becoming thin, bilious and fairly frequent. No sleep ; urine black and thin.
Fifth day. Deafness early in the day ; general exacerbation ; spleen swollen ; tension of the hypochondrium ; scanty black stools ; delirium.
Sixth day. Wandering talk ; at night sweat and chill ; the wandering persisted.
Seventh Day. Chill all over ; thirst ; out of his mind. During the night he was rational, and slept.
Eighth day. Fever ; spleen lessened ; quite rational ; pain at first in the groin, on the side of the spleen ; then the pains extended to both legs. Night comfortable ; urine of a better colour, with a slight deposit.
Ninth day. Sweat, crisis, intermission. On the fifth day after the crisis the patient relapsed. Immediately the spleen swelled ; acute fever ; return of deafness. On the third day after the relapse the spleen grew less and the deafness diminished, but there was pain in the legs. During the night he sweated. The crisis was about the seventeenth day. There was no delirium during the relapse.
CASE IV
In Thasos the wife of Philinus gave birth to a daughter. The lochial discharge was normal, and the mother was doing well when on the fourteenth day after delivery she was seized with fever attended with rigor. At first she suffered in the stomach and the right hypochondrium. Pains in the genital organs. The discharge ceased. By a pessary these troubles were eased, but pains persisted in the head, neck and loins. No sleep ; extremities cold ; thirst ; bowels burnt ; scanty stools ; urine thin, and at first colourless.
Sixth day. Much delirium at night, followed by recovery of reason.
Seventh day. Thirst ; stools scanty, bilious, highly coloured.
Eighth day. Rigor ; acute fever ; many painful convulsions ; much delirium. The application of a suppository made her keep going to stool, and there were copious motions with a bilious flux. No sleep.
Ninth day. Convulsions.
Tenth day. Lucid intervals.
Eleventh day. Slept ; complete recovery of her memory, followed quickly by renewed delirium. A copious passing of urine with convulsions — her attendants seldom reminding her — which was white and thick, like urine with a sediment and then shaken ; it stood for a long time without forming a sediment ; colour and consistency like that of the urine of cattle. Such was the nature of the urine that I myself saw.
About the fourteenth day there were twitchings over all the body ; much wandering, with lucid intervals followed quickly by renewed delirium. About the seventeenth day she became speechless.
Twentieth day. Death.
CASE V
The wife of Epicrates, who lay sick near the founder, when near her delivery was seized with severe rigor without, it was said, becoming warm, and the same symptoms occurred on the following day. On the third day she gave birth to a daughter, and the delivery was in every respect normal. On the second day after the delivery she was seized with acute fever, pain at the stomach and in the genitals. A pessary relieved these symptoms, but there was pain in the head, neck and loins. No sleep. From the bowels passed scanty stools, bilious, thin and unmixed. Urine thin and blackish. Delirium on the night of the sixth day from the day the fever began.
Seventh day. All symptoms exacerbated ; sleeplessness ; delirium ; thirst ; bilious, highly-coloured stools.
Eighth day. Rigor ; more sleep.
Ninth day. The same symptoms. Tenth day. Severe pains in the legs ; pain again at the stomach ; heaviness in the head ; no delirium ; more sleep ; constipation.
Eleventh day. Urine of better colour, with a thick deposit ; was easier.
Fourteenth day. Rigor ; acute fever.
Fifteenth day. Vomited fairly frequently bilious, yellow vomit ; sweated without fever ; at night, however, acute fever ; urine thick, with a white sediment.
Sixteenth day. Exacerbation ; an uncomfortable night ; no sleep ; delirium.
Eighteenth day. Thirst ; tongue parched ; no sleep ; much delirium ; pain in the legs.
About the twentieth day. Slight rigors in the early morning ; coma ; quiet sleep ; scanty, bilious, black vomits ; deafness at night.
About the twenty-first day. Heaviness all over the left side, with pain ; slight coughing ; urine thick, turbid, reddish, no sediment on standing. In other respects easier ; no fever. From the beginning she had pain in the throat ; redness ; uvula drawn back ; throughout there persisted an acrid flux, smarting, and salt.
About the twenty-seventh day. No fever ; sediment in urine ; some pain in the side.
About the thirty-first day. Attacked by fever ; bowels disordered and bilious.
Fortieth day. Scanty, bilious vomits.
Eightieth day. Complete crisis with cessation of fever.
CASE VI
Cleanactides, who lay sick above the temple of Heracles, was seized by an irregular fever. He had at the beginning pains in the head and the left side, and in the other parts pains like those caused by fatigue. The exacerbations of the fever were varied and irregular ; sometimes there were sweats, sometimes there were not. Generally the exacerbations manifested themselves most on the critical days.
About the twenty-fourth day. Pain in the hands ; bilious, yellow vomits, fairly frequent, becoming after a while like verdigris ; general relief.
About the thirtieth day. Epistaxis from both nostrils began, and continued, irregular and slight, until the crisis. All the time he suffered no thirst, nor lack of appetite or sleep. Urine thin, and not colourless.
About the fortieth day. Urine reddish, and with an abundant, red deposit. Was eased. Afterwards the urine varied, sometimes having, sometimes not having, a sediment.
Sixtieth day. Urine had an abundant sediment, white and smooth ; general improvement ; fever intermitted ; urine again thin but of good colour.
Seventieth day. Fever, which intermitted for ten days.
Eightieth day. Rigor ; attacked by acute fever ; much sweat ; in the urine a red, smooth sediment. A complete crisis.
CASE VII
Meton was seized with fever, and painful heaviness in the loins.
Second day. After a fairly copious draught of water had his bowels well moved.
Third day. Heaviness in the head ; stools thin, bilious, rather red. Fourth day. General exacerbation ; slight epistaxis twice from the right nostril. An uncomfortable night ; stools as on the third day ; urine rather black ; had a rather black cloud floating in it, spread out, which did not settle.
Fifth day. Violent epistaxis of unmixed blood from the left nostril ; sweat ; crisis. After the crisis sleeplessness ; wandering ; urine thin and rather black. His head was bathed ; sleep ; reason restored. The patient suffered no relapse, but after the crisis bled several times from the nose.
CASE VIII
Erasinus lived by the gully of Boétes. Was seized with fever after supper ; a troubled night.
First day. Quiet, but the night was painful.
Second day. General exacerbation ; delirium at night.
Third day. Pain and much delirium.
Fourth day. Very uncomfortable ; no sleep at night ; dreams and wandering. Then worse symptoms, of a striking and significant character ; fear and discomfort.
Fifth day. Early in the morning was composed, and in complete possession of his senses. But long before mid-day was madly delirious ; could not restrain himself ; extremities cold and rather livid ; urine suppressed ; died about sunset.
In this patient the fever was throughout accompanied by sweat ; the hypochondria were swollen, distended and painful. Urine black, with round, suspended particles which did not settle. There were solid discharges from the bowels. Thirst throughout not very great. Many convulsions with sweating about the time of death.
CASE IX
Crito, in Thasos, while walking about, was seized with a violent pain in the great toe. He took to bed the same day with shivering and nausea ; regained a little warmth ; at night was delirious.
Second day. Swelling of the whole foot, which was rather red about the ankle, and distended ; black blisters ; acute fever ; mad delirium. Alvine discharges unmixed, bilious and rather frequent. He died on the second day from the commencement.
CASE X
The man of Clazomenae, who lay sick by the well of Phrynichides, was seized with fever. Pain at the beginning in head, neck and loins, followed immediately by deafness. No sleep ; seized with acute fever ; hypochondrium swollen, but not very much ; distension ; tongue dry.
Fourth day. Delirium at night.
Fifth day. Painful.
Sixth day. All symptoms exacerbated.
About the eleventh day slight improvement. From the beginning to the fourteenth day there were from the bowels thin discharges, copious, of a watery biliousness ; they were well supported by the patient. Then the bowels were constipated. Urine throughout thin, but of good colour. It had much cloud spread through it, which did not settle in a sediment. About the sixteenth day the urine was a little thicker, and had a slight sediment. The patient became a little easier, and was more rational.
Seventeenth day. Urine thin again ; painful swellings by both ears. No sleep ; wandering ; pain in the legs.
Twentieth day. A crisis left the patient free from fever ; no sweating ; quite rational. About the twenty-seventh day violent pain in the right hip, which quickly ceased. The swellings by the ears neither subsided nor suppurated, but continued painful. About the thirty-first day diarrhéa with copious, watery discharges and signs of dysentery. Urine thick ; the swellings by the ears subsided.
Fortieth day. Pain in the right eye ; sight rather impaired ; recovery.
CASE XI
The wife of Dromeades, after giving birth to a daughter, when everything had gone normally, on the second day was seized with rigor ; acute fever. On the first day she began to feel pain in the region of the hypochondrium ; nausea ; shivering ; restless ; and on the following days did not sleep. Respiration rare, large, interrupted at once as by an inspiration.
Second day from rigor. Healthy action of the bowels. Urine thick, white, turbid, like urine which has settled, stood a long time, and then been stirred up. It did not settle. No sleep at night.
Third day. At about mid-day rigor ; acute fever ; urine similar ; pain in the hypochondrium ; nausea ; an uncomfortable night without sleep ; a cold sweat all over the body, but the patient quickly recovered heat. Fourth day. Slight relief of the pains about the hypochondrium ; painful heaviness of the head ; somewhat comatose ; slight epistaxis ; tongue dry ; thirst ; scanty urine, thin and oily ; snatches of sleep.
Fifth day. Thirst ; nausea ; urine similar ; no movement of the bowels ; about mid-day much delirium, followed quickly by lucid intervals ; rose, but grew somewhat comatose ; slight chilliness ; slept at night ; was delirious.
Sixth day. In the morning had a rigor ; quickly recovered heat ; sweated all over ; extremities cold ; was delirious ; respiration large and rare. After a while convulsions began from the head, quickly followed by death.
CASE XII
A man dined when hot and drank too much. During the night he vomited everything ; acute fever ; pain in the right hypochondrium ; inflammation, soft underneath, from the inner part; an uncomfortable night ; urine at the first thick and red ; on standing it did not settle ; tongue dry ; no great thirst.
Fourth day. Acute fever ; pains all over.
Fifth day. Passed much smooth, oily urine ; acute fever.
Sixth day. In the afternoon much delirium. No sleep at night.
Seventh day. General exacerbation ; urine similar ; much rambling ; could not restrain himself ; on stimulation the bowels passed watery, disturbed discharges, with worms. An uncomfortable night, with rigor in the morning. Acute fever. Hot sweat, and the patient seemed to lose his fever ; little sleep, followed by chilliness ; expectoration. In the evening much delirium, and shortly afterwards he vomited black, scanty, bilious vomits.
Ninth day. Chill ; much wandering ; no sleep.
Tenth day. Legs painful ; general exacerbation ; wandering.
Eleventh day. Death.
CASE XIII
A woman lying sick by the shore, who was three months gone with child, was seized with fever, and immediately began to feel pains in the loins.
Third day. Pain in the neck and in the head, and in the region of the right collar-bone. Quickly she lost her power of speech, the right arm was paralyzed, with a convulsion, after the manner of a stroke ; completely delirious. An uncomfortable night, without sleep ; bowels disordered with bilious, unmixed, scanty stools.
Fourth day. Her speech was recovered, but was indistinct ; convulsions ; pains of the same parts remained ; painful swelling in the hypochondrium ; no sleep ; utter delirium ; bowels disordered ; urine thin, and not of good colour.
Fifth day. Acute fever ; pain in the hypochondrium ; utter delirium ; bilious stools. At night sweated ; was without fever.
Sixth day. Rational ; general relief, but pain remained about the left collar-bone ; thirst ; urine thin ; no sleep.
Seventh day. Trembling ; some coma ; slight delirium ; pains in the region of the collar-bone and left upper arm remained ; other symptoms relieved ; quite rational. For three days there was an intermission of fever.
Eleventh day. Relapse ; rigor ; attack of fever. But about the fourteenth day the patient vomited bilious, yellow matter fairly frequently ; sweated ; a crisis took off the fever.
CASE XIV
Melidia, who lay sick by the temple of Hera, began to suffer violent pain in the head, neck and chest. Immediately she was attacked by acute fever, and there followed a slight menstrual flow. There were continuous pains in all these parts.
Sixth day. Coma ; nausea ; shivering ; flushed cheeks ; slight delirium.
Seventh day. Sweat ; intermittence of fever ; the pains persisted ; relapse ; snatches of sleep ; urine throughout of good colour but thin ; stools thin, bilious, irritating, scanty, black and of bad odour ; sediment in the urine white and smooth ; sweating.
Eleventh day. Perfect crisis.
CASE I
Pythion, who lived by the temple of Earth, was seized with trembling which began in the hands.
First day. Acute fever ; wandering.
Second day. General exacerbation.
Third day. Same symptoms.
Fourth day. Stools scanty, uncompounded and bilious.
Fifth day. General exacerbation ; fitful sleep ; constipation.
Sixth day. Varied, reddish sputa.
Seventh day. Mouth drawn awry.
Eighth day. General exacerbation ; tremblings persisted ; urine from the beginning to the eighth day thin, colourless, with a cloudy substance floating in it.
Tenth day. Sweat ; sputa somewhat concocted ; crisis ; urine somewhat thin about the time of the crisis. After the crisis, forty days subsequent to it, abscess in the seat, and an abscession through strangury.
CASE II
Hermocrates, who lay sick by the new wall, was seized with fever. He began to feel pain in the head and loins ; tension of the hypochondrium without swelling; tongue at the beginning parched ; deafness at once ; no sleep ; no great thirst ; urine thick, red, with no sediment on standing ; stools not scanty, and burnt.
Fifth day. Urine thin, with particles floating in it, without sediment ; at night delirium.
Sixth day. Jaundice ; general exacerbation ; not rational.
Seventh day. Discomfort ; urine thin, and as before. The following days similar. About the eleventh day there seemed to be general relief ; coma began ; urine thicker, reddish, thin at the bottom, without sediment ; by degrees grew more rational.
Fourteenth day. No fever ; no sweat ; sleep ; reason quite recovered ; urine as before.
About the seventeenth day there was a relapse, and the patient grew hot. On the following days there was acute fever ; urine thin ; delirium.
Twentieth day. A fresh crisis ; no fever ; no sweat. All the time the patient had no appetite ; was perfectly collected but could not talk ; tongue dry ; no thirst ; snatches of sleep ; coma. About the twenty-fourth day he grew hot ; bowels loose with copious, thin discharges. On the following days acute fever ; tongue parched.
Twenty-seventh day. Death.
In this case deafness persisted throughout ; urine thick, red, without settling, or thin, colourless, with substances floating in it. The patient had no power to take food.
CASE III
The man lying sick in the garden of Delearces had for a long time heaviness in the head and pain in the right temple. From some exciting cause he was seized with fever, and took to his bed.
Second day. Slight flow of unmixed blood from the left nostril. The bowels were well moved ; urine thin and varied, with particles in small groups, like barley-meal or semen, floating in it.
Third day. Acute fever ; stools black, thin, frothy, with a livid sediment in them ; slight stupor ; getting up caused distress ; in the urine a livid, rather viscous sediment.
Fourth day. Vomited scanty, bilious, yellow vomits, and after a short interval, verdigris-coloured ones ; slight flow of unmixed blood from the left nostril ; stools unaltered and urine unaltered ; sweat about the head and collar-bones ; spleen enlarged ; pain in the direction of the thigh ; tension, soft under-neath, of the right hypochondrium ; no sleep at night ; slight delirium.
Fifth day. Stools more copious, black, frothy ; a black sediment in the stools ; no sleep at night ; delirium.
Sixth day. Stools black, oily, viscid, foul-smelling ; slept ; was more rational.
Seventh day. Tongue dry ; thirsty ; no sleep ; delirium ; urine thin, not of a good colour.
Eighth day. Stools black, scanty, compact ; sleep ; was collected ; not very thirsty.
Ninth day. Rigor, acute fever ; sweat ; chill ; delirium ; squinting of the right eye ; tongue dry ; thirsty ; sleepless. Tenth day. Symptoms about the same.
Eleventh day. Quite rational ; no fever ; slept, urine thin about the time of the crisis.
The patient remained free from fever for two days, relapsed on the fourteenth day, and immediately had no sleep at night and was completely delirious.
Fifteenth day. Urine muddy, like that which has been stirred up after settling ; acute fever ; completely delirious ; no sleep ; pain in knees and legs. On the application of a suppository, black, solid motions were passed.
Sixteenth day. Urine thin, with a cloudy substance floating in it ; delirium.
Seventeenth day. Extremities cold in the early morning ; would wrap himself up ; acute fever ; sweated all over ; was relieved ; more rational ; some fever ; thirst ; vomited bilious matters, yellow and scanty ; solid motions from the bowels ; after a while they became black, scanty and thin ; urine thin, and not of a good colour.
Eighteenth day. Was not rational ; comatose.
Nineteenth day. The same symptoms.
Twentieth day. Slept ; completely rational ; sweated ; no fever ; no thirst ; urine thin.
Twenty-first day. Slightly delirious ; rather thirsty ; pain in the hypochondrium and throbbing about the navel continuously.
Twenty-fourth day. Sediment in urine ; completely rational.
Twenty-seventh day. Pain in the right hip, but in other respects very comfortable ; sediment in the urine.
About the twenty-ninth day pain in the right eye ; urine thin. Fortieth day. Passed motions full of phlegm, white and rather frequent ; copious sweat all over ; a perfect crisis.
CASE IV
Philistes in Thasos had for a long time pain in the head, and at last fell into a state of stupor and took to his bed. Heavy drinking having caused continuous fevers the pain grew worse. At night he grew hot at the first.
First day. Vomited bilious matters, scanty, at first yellow, afterwards increasing and of the colour of verdigris ; solid motions from the bowels ; an uncomfortable night.
Second day. Deafness ; acute fever ; tension of the right hypochondrium, which fell inwards. Urine thin, transparent, with a small quantity of substance, like semen, floating in it. About mid-day became raving.
Third day. Uncomfortable.
Fourth day. Convulsions ; exacerbation.
Fifth day. Died early in the morning.
CASE V
Chaerion, who lay sick in the house of Demaenetus, was seized with fever after drinking. At once there was painful heaviness of the head ; no sleep ; bowels disturbed with thin, rather bilious stools.
Third day. Acute fever, trembling of the head, particularly of the lower lip ; after a while rigor, convulsions, complete delirium ; an uncomfortable night.
Fourth day. Quiet ; snatches of sleep ; wandering. Fifth day. Pain ; general exacerbation ; irrational talk ; uncomfortable night ; no sleep.
Sixth day. The same symptoms.
Seventh day. Rigor ; acute fever ; sweating all over ; crisis.
This patient’s stools were throughout bilious, scanty and uncompounded. Urine thin, not of a good colour, with a cloudy substance floating in it. About the eighth day the urine had a better colour, with a slight, white sediment ; quite rational and no fever ; an intermission.
Ninth day. Relapse.
About the fourteenth day acute fever.
Sixteenth day. Vomited bilious, yellow matters rather frequently.
Seventeenth day. Rigor ; acute fever ; sweating ; crisis ended the fever.
Urine after relapse and crisis of a good colour, with a sediment ; no delirium during the relapse.
Eighteenth day. Slight heat ; rather thirsty ; urine thin, with cloudy substance floating in it ; slight delirium.
Nineteenth day. No fever ; pain in the neck ; sediment in urine.
Twentieth day. Complete crisis.
CASE VI
The maiden daughter of Euryanax was seized with fever. Throughout the illness she suffered no thirst and had no inclination for food. Slight alvine discharges ; urine thin, scanty, and not of a good colour. At the beginning of the fever suffered pain in the seat. On the sixth day did not sweat, being without fever ; a crisis. The sore near the seat suppurated slightly, and burst at the crisis. After the crisis, on the seventh day, she had a rigor ; grew slightly hot ; sweated. Afterwards the extremities always cold. About the tenth day, after the sweating that occurred, she grew delirious, but was soon rational again. They said that the trouble was due to eating grapes. After an intermission, on the twelfth day she again wandered a great deal ; the bowels were disturbed, with bilious, uncompounded, scanty, thin, irritating stools, which frequently made her get up. She died the seventh day from the second attack of delirium. This patient at the beginning of the illness had pain in the throat, which was red throughout. The uvula was drawn back. Many fluxes, scanty and acrid. She had a cough with signs of coction, but brought up nothing. No appetite for any food the whole time, nor did she desire anything. No thirst, and she drank nothing worth mentioning. She was silent, and did not converse at all. Depression, the patient despairing of herself. There was also some inherited tendency to consumption.
CASE VII
The woman suffering from angina who lay sick in the house of Aristion began her complaint with indistinctness of speech. Tongue red, and grew parched.
First day. Shivered, and grew hot. Third day. Rigor ; acute fever ; a reddish, hard swelling in the neck, extending to the breast on either side ; extremities cold and livid, breathing elevated ; drink returned through the nostrils — she could not swallow — stools and urine ceased.
Fourth day. General exacerbation.
Fifth day. Death.
CASE VIII
The youth who lay sick by the Liars’ Market was seized with fever after unaccustomed fatigue, toil and running.
First day. Bowels disturbed with bilious, thin, copious stools ; urine thin and blackish ; no sleep ; thirst.
Second day. General exacerbation ; stools more copious and more unfavourable. No sleep ; mind disordered ; slight sweating.
Third day. Uncomfortable ; thirst ; nausea ; much tossing ; distress ; delirium ; extremities livid and cold ; tension, soft underneath, of the hypochondrium on both sides.
Fourth day. No sleep ; grew worse.
Seventh day. Died, being about twenty years old.
CASE IX
The woman who lodged with Tisamenus was in bed with a troublesome attack of inflammation of the upper bowel. Copious vomits ; could not retain her drink. Pains in the region of the hypochondria. The pains were also lower, in the region of the bowels. Constant tormina. No thirst. She grew hot, though the extremities were cold all the time. Nausea ; sleeplessness. Urine scanty and thin. Excreta crude, thin and scanty. It was no longer possible to do her any good, and she died.
CASE X
A woman who was one of the house of Pantimides after a miscarriage was seized with fever on the first day. Tongue dry ; thirst ; nausea ; sleeplessness. Bowels disordered, with thin, copious and crude stools.
Second day. Rigor ; acute fever ; copious stools ; no sleep.
Third day. The pains greater.
Fourth day. Delirium.
Seventh day. Death.
The bowels were throughout loose, with copious, thin, crude stools. Urine scanty and thin.
CASE XI
Another woman, after a miscarriage about the fifth month, the wife of Hicetas, was seized with fever. At the beginning she had alternations of coma and sleeplessness ; pain in the loins ; heaviness in the head.
Second day. Bowels disordered with scanty, thin stools, which at first were uncompounded.
Third day. Stools more copious and worse ; no sleep at night.
Fourth day. Delirium ; fears ; depression. Squinting of the right eye ; slight cold sweat about the head ; extremities cold.
Fifth day. General exacerbation ; much wandering, with rapid recovery of reason ; no thirst ; no sleep ; stools copious and unfavourable throughout ; urine scanty, thin and blackish ; extremities cold and rather livid.
Sixth day. Same symptoms.
Seventh day. Death.
CASE XII
A woman who lay sick by the Liars’ Market, after giving birth in a first and painful delivery to a male child, was seized with fever. From the very first there was thirst, nausea, slight pain at the stomach, dry tongue, bowels disordered with thin and scanty discharges, no sleep.
Second day. Slight rigor ; acute fever ; slight, cold sweating around the head.
Third day. In pain ; crude, thin, copious discharges from the bowels.
Fourth day. Rigor ; general exacerbation ; sleepless.
Fifth day. In pain.
Sixth day. The same symptoms ; copious, fluid discharges from the bowels.
Seventh day. Rigor ; acute fever ; thirst ; much tossing ; towards evening cold sweat all over ; chill ; extremities cold, and would not be warmed. At night she again had a rigor ; the extremities would not be warmed ; no sleep ; slight delirium, but quickly was rational again.
Eighth day. About mid-day recovered her heat ; thirst ; coma ; nausea ; vomited bilious, scanty, yellowish matters. An uncomfortable night ; no sleep ; unconsciously passed a copious discharge of urine. Ninth day. General abatement of the symptoms ; coma. Towards evening slight rigor ; vomited scanty, bilious matters.
Tenth day. Rigor ; exacerbation of the fever ; no sleep whatsoever. In the early morning a copious discharge of urine without sediment ; extremities were warmed.
Eleventh day. Vomited bilious matters, of the colour of verdigris. A rigor shortly afterwards, and the extremities became cold again ; in the evening sweat, rigor and copious vomiting ; a painful night.
Twelfth day. Vomited copious, black, fetid matters ; much hiccoughing ; painful thirst.
Thirteenth day. Vomited black, fetid, copious matters ; rigor. About mid-day lost her speech.
Fourteenth day. Epistaxis ; death.
The bowels of this patient were throughout loose, and there were shivering fits. Age about seventeen.
II. The year was southerly and rainy, with no winds throughout. About the rising of Arcturus, while during the immediately preceding period droughts had prevailed, there were now heavy rains, with southerly winds. Autumn dark and cloudy, with abundance of rain. The winter southerly, humid, and mild after the solstice. Long after the solstice, near the equinox, wintry weather returned, and at the actual equinoctial period there were northerly winds with snow, but not for long. The spring southerly again, with no winds ; many rains throughout until the Dog Star. The summer was clear and warm, with waves of stifling heat. The Etesian winds were faint and intermittent. But, on the other hand, near the rising of Arcturus there were heavy rains with northerly winds.
The year having proved southerly, wet and mild, in the winter the general health was good except for the consumptives, who will be described in due course.
III. Early in the spring, at the same time as the cold snaps which occurred, were many malignant cases of erysipelas, some from a known exciting cause and some not. Many died, and many suffered pain in the throat. Voices impaired ; ardent fevers ; phrenitis ; aphthae in the mouth ; tumours in the private parts ; inflammations of the eyes ; carbuncles ; disordered bowels ; loss of appetite ; thirst in some cases, though not in all ; urine disordered, copious, bad ; long coma alternating with sleeplessness ; absence of crisis in many cases, and obscure crises ; dropsies ; many consumptives. Such were the diseases epidemic. There were patients suffering from each of the above types, and fatal cases were many. The symptoms in each type were as follow.
IV. Many were attacked by the erysipelas all over the body when the exciting cause was a trivial accident or a very small wound ; especially when the patients were about sixty years old and the wound was in the head, however little the neglect might have been. Many even while undergoing treatment suffered from severe inflammations, and the erysipelas would quickly spread widely in all directions. Most of the patients experienced abscessions ending in suppurations. Flesh, sinews and bones fell away in large quantities. The flux which formed was not like pus, but was a different sort of putre-faction with a copious and varied flux. If any of these symptoms occurred in the head, there was loss of hair from all the head and from the chin ; the bones were bared and fell away, and there were copious fluxes. Fever was sometimes present and sometimes absent. These symptoms were terrifying rather than dangerous. For whenever they resulted in suppuration or some similar coction the cases usually recovered. But whenever the inflammation and the erysipelas disappeared without producing any such abscession, there were many deaths. The course of the disease was the same to whatever part of the body it spread. Many lost the arm and the entire forearm. If the malady settled in the sides there was rotting either before or behind. In some cases the entire thigh was bared, or the shin and the entire foot. But the most dangerous of all such cases were when the pubes and genital organs were attacked. Such were the sores which sprang from an exciting cause. In many cases, however, sores occurred in fevers, before a fever, or supervening on fevers. In some of these also, when an abscession took place through suppuration, or when a seasonable disturbance of the bowels occurred or a passing of favourable urine, this gave rise to a solution ; but when none of these events happened, and the symptoms disappeared without a sign, death resulted. It was in the spring that by far the greater number of cases of erysipelas occurred, but they continued throughout the summer and during autumn.
V. Much trouble was caused to some patients by the tumours in the throat, inflammations of the tongue and the abscesses about the teeth. Many had the symptom of impaired and muffled voice, at first at the beginning of the cases of consumption, but also in the ardent fevers and in phrenitis.
VI. Now the ardent fevers and phrenitis began early in the spring after the cold snaps which occurred, and very many fell sick at that time. These suffered acute and fatal symptoms. The constitution of the ardent fevers that occurred was as follows. At the beginning coma, nausea, shivering, acute fever, no great thirst, no delirium, slight epistaxis. The exacerbations in most cases on even days, and about the time of the exacerbations there was loss of memory with prostration and speechlessness. The feet and hands of these patients were always colder than usual, most especially about the times of exacerbation. Slowly and in no healthy manner they recovered their heat, becoming rational again and conversing. Either the coma held them continuously without sleep, or they were wakeful and in pain. Bowels disordered in the majority of these cases, with crude, thin, copious stools. Urine copious, thin, with no critical or favourable sign, nor did any other critical sign appear in these patients. For there occurred neither favourable hemorrhage nor any other of the usual critical abscessions. The manner of their dying varied with the individual ; it was usually irregular, at the crises, but in some cases after long loss of speech and in many with sweating. These were the symptoms attending the fatal cases of ardent fever, and the cases of phrenitis were similar. These suffered from no thirst at all, and no case showed the mad delirium that attacked others, but they passed away overpowered by a dull oppression of stupor.
VII. There were other fevers also, which I shall describe in due course. Many had aphthae and sores in the mouth. Fluxes about the genitals were copious; sores, tumours external and internal ; the swellings which appear in the groin. Watery inflammations of the eyes, chronic and painful. Growths on the eyelids, external and internal, in many cases destroying the sight, which are called “figs.” There were also often growths on other sores, particularly in the genitals. Many carbuncles in the summer, and other affections called “rot.” Large pustules. Many had large tetters.
VIII. The bowel troubles in many cases turned out many and harmful. In the first place many were attacked by painful tenesmus, mostly children — all in fact who were approaching puberty — and most of these died. Many lienteries. Cases of dysentery, but they too were not very painful. Stools bilious, greasy, thin and watery. In many cases this condition of the bowels constituted the disease itself, fever being sometimes absent and sometimes present. Painful tormina and malignant colic. There were evacuations, though the bulk of the contents remained behind. The evacuations did not take away the pains, and yielded with difficulty to the remedies administered. Purgings, in fact, did harm in most cases. Of those in this condition many died rapidly, though a few held out longer. In brief, all patients, whether the disease was prolonged or acute, died chiefly from the bowel complaints. For the bowels carried all off together.
IX. Loss of appetite, to a degree that I never met before, attended all the cases described above, but most especially the last, and of them, and of the others also, especially such as were fatally stricken. Thirst afflicted some, but not others ; of the fever patients, as well as of the other cases, none were unseasonably affected, but as far as drink was concerned you could diet them as you pleased.
X. The urine that was passed was copious, not in proportion to, but far exceeding, the drink administered. Yet the urine too that was passed showed a great malignancy. For it had neither the proper consistency, nor coction, nor cleansing powers ; it signified for most patients wasting, trouble, pains, and absence of crisis.
XI. Coma attended mostly the phrenitis and ardent fevers, without excluding, however, all the other diseases of the most severe sort that were accompanied by fever. Most patients throughout either were sunk in heavy coma or slept only in fitful snatches.
XII. Many other forms also of fever were epidemic : — tertians, quartans, night fevers, fevers continuous, protracted, irregular, fevers attended with nausea, fevers of no definite character. All these cases suffered severely from trouble. For the bowels in most cases were disordered, with shivering fits. Sweats portended no crisis, and the character of the urine was as I have described. Most of these cases were protracted, for the abscessions too which took place did not prove critical as in other cases ; nay rather, in all cases all symptoms marked obscurity of crisis, or absence of crisis, or protraction of the disease, but most especially in the patients last described. A few of these had a crisis about the eightieth day ; with most recovery followed no rule. A few of them died of dropsy, without taking to their bed ; many sufferers from the other diseases too were troubled with swellings, most particularly the consumptives.
XIII. The severest and most troublesome disease, as well as the most fatal, was the consumption. Many cases began in the winter, and of these several took to their bed, though some went about ailing without doing so. Early in the spring most of those who had gone to bed died, while none of the others lost their cough, though it became easier in the summer. During autumn all took to bed and many died. Most of these were ill for a long time. Now most of these began suddenly to grow worse, showing the following symptoms : — frequent shivering ; often continuous and acute fever ; unseasonable, copious, cold sweats throughout ; great chill with difficult recovery of heat ; bowels variously constipated, then quickly relaxing, and violently relaxing in all cases near the end ; the humours about the lungs spread downwards ; abundance of unfavourable urine ; malignant wasting. The coughs throughout were frequent, bringing up copious, concocted and liquid sputa, but without much pain ; but even if there was pain, in all cases the purging from the lungs took place very mildly. The throat did not smart very much, nor did salt humours cause any distress at all. The fluxes, however, viscid, white, moist, frothy, which came from the head, were abundant. But by far the worst symptom that attended both these cases and the others was the distaste for food, as has been mentioned. They had no relish either for drink with nourishment, but they remained entirely without thirst. Heaviness in the body. Coma. In most of them there was swelling, which developed into dropsy. Shivering fits and delirium near death.
XIV. The physical characteristics of the consumptives were : — skin smooth, whitish, lentil-coloured, reddish ; bright eyes ; a leucophlegmatic condition ; shoulder-blades projecting like wings. Women too so. As to those with a melancholic or a rather sanguine complexion, they were attacked by ardent fevers, phrenitis and dysenteric troubles. Tenesmus affected young, phlegmatic people ; the chronic diarrhoea and acrid, greasy stools affected persons of a bilious temperament.
XV. In all the cases described spring was the worst enemy, and caused the most deaths ; summer was the most favourable season, in which fewest died. In autumn and during the season of the Pleiades, on the other hand, there were again deaths, usually on the fourth day. And it seems to me natural that the coming on of summer should have been helpful. For the coming on of winter resolves the diseases of summer, and the coming on of summer removes those of winter. And yet in itself the summer in question was not healthful ; in fact it was suddenly hot, southerly, and calm. But nevertheless the change from the other constitution proved beneficial.
XVI. The power, too, to study correctly what has been written I consider to be an important part of the art of medicine. The man who has learnt these things and uses them will not, I think, make great mistakes in the art. And it is necessary to learn accurately each constitution of the seasons as well as the disease ; what common element in the constitution or in the disease is good, and what common element in the constitution or in the disease is bad ; what malady is protracted and fatal, what is protracted and likely to end in recovery ; what acute illness is fatal, what acute illness is likely to end in recovery. With this knowledge it is easy to examine the order of the critical days, and to prognosticate therefrom. One who has knowledge of these matters can know whom he ought to treat, as well as the time and method of treatment.
CASE I
XVII. In Thasos the Parian who lay sick beyond the temple of Artemis was seized with acute fever, which at the beginning was continuous and ardent. Thirst. At the beginning coma followed by sleeplessness. Bowels disordered at the beginning ; urine thin.
Sixth day. Oily urine ; delirium.
Seventh day. General exacerbation ; no sleep ; urine similar and mind disordered ; stools bilious and fatty.
Eighth day. Slight epistaxis ; vomited scanty matters of the colour of verdigris ; snatches of sleep.
Ninth day. Same symptoms.
Tenth day. General improvement.
Eleventh day. Sweated all over ; grew chilly, but quickly recovered heat.
Fourteenth day. Acute fever ; stools bilious, thin, copious ; substance floating in urine ; delirium.
Seventeenth day. In pain ; no sleep, while the fever grew worse.
Twentieth day. Sweated all over ; no fever ; stools bilious ; aversion to food ; coma.
Twenty-fourth day. Relapse.
Thirty-fourth day. No fever ; no constipation ; recovered heat.
Fortieth day. No fever ; bowels constipated for a short time ; aversion to food ; became slightly feverish again, throughout irregularly, the fever being sometimes absent, sometimes present ; for if the fever intermitted and was alleviated there was a relapse soon afterwards. He took little bits of food, and that of an unsuitable sort. Sleep bad ; delirium at the relapses. Urine at these times had consistency, but was troubled and bad. Bowels constipated, but afterwards relaxed. Continuous slight fevers. Stools thin and copious.
Hundred and twentieth day. Death.
In this case the bowels continuously from the first day loose with bilious, loose, copious stools, or constipated with hot, undigested stools. Urine throughout bad ; mostly comatose ; painful sleeplessness ; continued aversion to food.
CASE II
In Thasos the woman who lay sick by the Cold Water, on the third day after giving birth to a daughter without lochial discharge, was seized with acute fever accompanied by shivering. For a long time before her delivery she had suffered from fever, being confined to bed and averse to food. After the rigor that took place, the fevers were continuous, acute, and attended with shivering.
Eighth and following days. Much delirium, quickly followed by recovery of reason ; bowels disturbed with copious, thin, watery and bilious stools ; no thirst.
Eleventh day. Was rational, but comatose. Urine copious, thin and black ; no sleep.
Twentieth day. Slight chills, but heat quickly recovered ; slight wandering ; no sleep ; bowels the same ; urine watery and copious.
Twenty-seventh day. No fever ; bowels constipated ; not long afterwards severe pain in the right hip for a long time. Fevers again attended ; urine watery.
Fortieth day. Pain in the hip relieved ; continuous coughing, with watery, copious sputa ; bowels constipated ; aversion to food ; urine the same. The fevers, without entirely intermitting, were exacerbated irregularly, sometimes increasing and sometimes not doing so.
Sixtieth day. The coughing ceased without any critical sign ; there was no coction of the sputa, nor any of the usual abscessions ; jaw on the right side convulsed ; comatose ; wandering, but reason quickly recovered ; desperately averse to food ; jaw relaxed ; passed small, bilious stools ; fever grew more acute, with shivering. On the succeeding days she lost power of speech, but would afterwards converse.
Eightieth day. Death.
The urine of this patient was throughout black, thin and watery. Coma was present, aversion to food, despondency, sleeplessness, irritability, restlessness, the mind being affected by melancholy.
CASE III
In Thasos Pythion, who lay sick above the shrine of Heracles, after labour, fatigue and careless living, was seized by violent rigor and acute fever. Tongue dry ; thirst ; bilious ; no sleep ; urine rather black, with a substance suspended in it, which formed no sediment.
Second day. About mid-day chill in the extremities, especially in the hands and head ; could not speak or utter a sound ; respiration short for a long time ; recovered warmth ; thirst ; a quiet night ; slight sweats about the head.
Third day. A quiet day, but later, about sunset, grew rather chilly ; nausea ; distress ; painful night without sleep ; small, solid stools were passed.
Fourth day. Early morning peaceful, but about mid-day all symptoms were exacerbated ; chill ; speechless and voiceless ; grew worse ; recovered warmth after a time ; black urine with a substance floating in it ; night peaceful ; slept.
Fifth day. Seemed to be relieved, but there was heaviness in the bowels with pain ; thirst ; painful night.
Sixth day. Early morning peaceful ; towards evening the pains were greater ; exacerbation ; but later a little clyster caused a good movement of the bowels. Slept at night.
Seventh day. Nausea ; rather uneasy ; urine oily ; much distress at night ; wandering ; no sleep at all.
Eighth day. Early in the morning snatches of sleep ; but quickly there was chill ; loss of speech ; respiration thin and weak ; in the evening he recovered warmth again ; was delirious ; towards morning slightly better ; stools uncompounded, small, bilious.
Ninth day. Comatose ; nausea whenever he woke up. Not over-thirsty. About sunset was uncomfortable ; wandered ; a bad night.
Tenth day. In the early morning was speechless ; great chill ; acute fever ; much sweat ; death.
In this case the pains on even days.
CASE IV
The patient suffering from phrenitis on the first day that he took to bed vomited copiously thin vomits of the colour of verdigris ; much fever with shivering ; continuous sweating all over ; painful heaviness of head and neck ; urine thin, with small, scattered substances floating in it, which did not settle. Copious excreta at a single evacuation ; delirium ; no sleep. Second day. In the early morning speechless ; acute fever ; sweating ; no intermission ; throbbing all over the body ; convulsions at night.
Third day. General exacerbation.
Fourth day. Death.
CASE V
In Larisa a bald man suddenly experienced pain in the right thigh. No remedy did any good.
First day. Acute fever of the ardent type ; the patient was quiet, but the pains persisted.
Second day. The pains in the thigh subsided, but the fever grew worse ; the patient was rather uncomfortable and did not sleep ; extremities cold ; copious and unfavourable urine was passed.
Third day. The pain in the thigh ceased, but there was derangement of the intellect, with distress and much tossing.
Fourth day. Death about mid-day.
CASE VI
In Abdera Pericles was seized with acute fever, continuous and painful ; much thirst ; nausea ; could not retain what he drank. There was slight enlargement of the spleen and heaviness in the head.
First day. Epistaxis from the left nostril ; the fever, however, increased greatly. Copious urine, turbid and white. On standing it did not settle.
Second day. General exacerbation ; the urine, however, had consistency, but there was some sediment ; the nausea was relieved and the patient slept.
Third day. The fever went down ; abundance of urine, with concocted and copious sediment ; a quiet night. Fourth day. About mid-day a hot, violent sweating all over ; no fever ; crisis ; no relapse.
CASE VII
In Abdera the maiden who lay sick by the Sacred Way was seized with a fever of the ardent type. She was thirsty and sleepless. Menstruation occurred for the first time.
Sixth day. Much nausea ; redness ; shivering ; restlessness.
Seventh day. Same symptoms. Urine thin but of good colour ; no trouble in the bowels.
Eighth day. Deafness ; acute fever ; sleeplessness ; nausea ; shivering ; was rational ; urine similar.
Ninth day Same symptoms, and also on the following days. The deafness persisted.
Fourteenth day. Reason disturbed ; the fever subsided.
Seventeenth day. Copious epistaxis ; the deafness improved a little. On the following days nausea and deafness, while there was also delirium.
Twentieth day. Pain in the feet ; deafness ; the delirium ceased ; slight epistaxis ; sweating ; no fever.
Twenty-fourth day. The fever returned, with the deafness ; pain in the feet persisted ; delirium.
Twenty-seventh day. Copious sweating ; no fever ; the deafness ceased ; the pain in the feet remained, but in other respects there was a perfect crisis.
CASE VIII
In Abdera Anaxion, who lay sick by the Thracian gate, was seized with acute fever. Continuous pain in the right side ; a dry cough, with no sputa on the first days. Thirst ; sleeplessness ; urine of good colour, copious and thin.
Sixth day. Delirium ; warm applications gave no relief.
Seventh day. In pain, for the fever grew worse and the pains were not relieved, while the coughing was troublesome and there was difficulty in breathing.
Eighth day. I bled him in the arm. There was an abundant, proper flow of blood ; the pains were relieved, although the dry coughing persisted.
Eleventh day. The fever went down ; slight sweating about the head ; the coughing and the sputa more moist.
Seventeenth day. Began to expectorate small, concocted sputa ; was relieved.
Twentieth day. Sweated and was free from fever ; after a crisis was thirsty, and the cleansings from the lungs were not favourable.
Twenty-seventh day. The fever returned ; coughing, with copious, concocted sputa ; copious, white sediment in urine ; thirst and difficulty in breathing disappeared.
Thirty-fourth day. Sweated all over ; no fever ; general crisis.
CASE IX
In Abdera Heropythus had pain in the head without taking to bed, but shortly afterwards was compelled to do so. He lived close to the Upper Road. An acute, ardent fever seized him. Vomited at the beginning copious, bilious matters ; thirst ; great discomfort ; urine thin and black, sometimes with, sometimes without, substances suspended in it. Painful night, with fever rising now in this way, now in that, but for the most part irregularly. About the fourteenth day, deafness ; the fever grew worse ; urine the same.
Twentieth day. Much delirium, also on the following days.
Fortieth day. Copious epistaxis ; more rational ; some deafness, but less than before ; the fever went down. Frequent, but slight, epistaxis on the following days. About the sixtieth day the bleedings from the nose ceased, but there was violent pain in the right hip and the fever increased. Not long afterwards, pains in all the lower parts. It happened that either the fever was higher and the deafness great, or else, though these symptoms were relieved and less severe, yet the pains in the lower parts about the hips grew worse. But from about the eightieth day all the symptoms were relieved without any disappearing. The urine that was passed was of good colour and had greater deposits, while the delirious mutterings were less. About the hundredth day the bowels were disordered with copious, bilious stools, and copious evacuations of this nature were passed for a long time. Then followed painful symptoms of dysentery, with relief of the other symptoms. In brief, the fever disappeared and the deafness ceased.
Hundred and twentieth day. Complete crisis.
CASE X
In Abdera Nicodemus after venery and drunkenness was seized with fever. At the beginning he had nausea and cardialgia ; thirst ; tongue parched ; urine thin and black.
Second day. The fever increased ; shivering ; nausea ; no sleep ; bilious, yellow vomits ; urine the same ; a quiet night ; sleep.
Third day. All symptoms less severe ; relief. But about sunset he was again somewhat uncomfortable ; painful night.
Fourth day. Rigor ; much fever ; pains every-where ; urine thin, with floating substance in it ; the night, on the other hand, was quiet.
Fifth day. All symptoms present, but relieved.
Sixth day. Same pains everywhere ; substance floating in urine ; much delirium.
Seventh day. Relief.
Eighth day. All the other symptoms less severe.
Tenth day and following days. The pains were present, but all less severe. The exacerbations and the pains in the case of this patient tended through-out to occur on the even days.
Twentieth day. Urine white, having consistency ; no sediment on standing. Copious sweating ; seemed to lose his fever, but towards evening grew hot again, with pains in the same parts ; shivering ; thirst ; slight delirium.
Twenty-fourth day. Much white urine, with much sediment. Hot sweating all over ; the fever passed away in a crisis.
CASE XI
In Thasos a woman of gloomy temperament, after a grief with a reason for it, without taking to bed lost sleep and appetite, and suffered thirst and nausea. She lived near the place of Pylades on the plain.
First day. As night began there were fears, much rambling, depression and slight feverishness. Early in the morning frequent convulsions ; whenever these frequent convulsions intermitted, she wandered and uttered obscenities ; many pains, severe and continuous.
Second day. Same symptoms ; no sleep ; fever more acute.
Third day. The convulsions ceased, but were succeeded by coma and oppression, followed in turn by wakefulness. She would jump up ; could not restrain herself ; wandered a great deal ; fever acute ; on this night a copious, hot sweating all over ; no fever ; slept, was perfectly rational, and had a crisis. About the third day urine black and thin, with particles mostly round floating in it, which did not settle. Near the crisis copious menstruation.
CASE XII
In Larisa a maiden was seized with an acute fever of the ardent type. Sleeplessness ; thirst ; tongue sooty and parched ; urine of good colour, but thin.
Second day. In pain ; no sleep.
Third day. Copious stools, watery and of a yellowish green ; similar stools on the following days, passed without distress.
Fourth day. Scanty, thin urine, with a substance suspended in it which did not settle ; delirium at night.
Sixth day. Violent and abundant epistaxis ; after a shivering fit followed a hot, copious sweating all over ; no fever ; a crisis. In the fever and after the crisis menstruation for the first time, for she was a young maiden. Throughout she suffered nausea and shivering ; redness of the face ; pain in the eyes ; heaviness in the head. In this case there was no relapse, but a definite crisis. The pains on the even days.
CASE XIII
Apollonius in Abdera was ailing for a long time without being confined to bed. He had a swollen abdomen, and a continual pain in the region of the liver had been present for a long time ; moreover, he became during this period jaundiced and flatulent ; his complexion was whitish. After dining and drinking unseasonably cow’s milk he at first grew rather hot ; he took to his bed. Having drunk copiously of milk, boiled and raw, both goat’s and sheep’s, and adopting a thoroughly bad regimen, he suffered much therefrom. For there were exacerbations of the fever ; the bowels passed practically nothing of the food taken ; the urine was thin and scanty. No sleep. Grievous distension ; much thirst ; coma ; painful swelling of the right hypochondrium ; extremities all round rather cold ; slight delirious mutterings ; forgetfulness of every-thing he said ; he was not himself. About the fourteenth day from his taking to bed, after a rigor, he grew hot ; wildly delirious ; shouting, distress, much rambling, followed by calm ; the coma came on at this time. Afterwards the bowels were disordered with copious stools, bilious, uncompounded and crude ; urine black, scanty and thin. Great discomfort. The evacuations showed varying symptoms ; they were either black, scanty and verdigris-coloured, or else greasy, crude and smarting ; at times they seemed actually to be like milk. About the twenty-fourth day comfortable ; in other respects the same, but he had lucid intervals. He remembered nothing since he took to bed. But he quickly was again delirious, and all symptoms took a sharp turn for the worse. About the thirtieth day acute fever ; copious, thin stools ; wandering ; cold extremities ; speechlessness.
Thirty-fourth day. Death.
This patient throughout, from the time I had knowledge of the case, suffered from disordered bowels ; urine thin and black ; coma ; sleeplessness ; extremities cold ; delirious throughout.
CASE XIV
In Cyzicus a woman gave birth with difficult labour to twin daughters, and the lochial discharge was far from good.
First day. Acute fever with shivering ; painful heaviness of head and neck. Sleepless from the first, but silent, sulky and refractory. Urine thin and of no colour ; thirsty ; nausea generally ; bowels irregularly disturbed with constipation following.
Sixth day. Much wandering at night ; no sleep. About the eleventh day she went out of her mind and then was rational again ; urine black, thin, and then, after an interval, oily ; copious, thin, disordered stools.
Fourteenth day. Many convulsions ; extremities cold ; no further recovery of reason ; urine suppressed.
Sixteenth day. Speechless.
Seventeenth day. Death.
CASE XV
In Thasos the wife of Delearces, who lay sick on the plain, was seized after a grief with an acute fever with shivering. From the beginning she would wrap herself up, and throughout, without speaking a word, she would fumble, pluck, scratch, pick hairs, weep and then laugh, but she did not sleep ; though stimulated, the bowels passed nothing. She drank a little when the attendants suggested it. Urine thin and scanty ; fever slight to the touch ; coldness of the extremities.
Ninth day. Much wandering followed by return of reason ; silent.
Fourteenth day. Respiration rare and large with long intervals, becoming afterwards short.
Seventeenth day. Bowels under a stimulus passed disordered matters, then her very drink passed unchanged ; nothing coagulated. The patient noticed nothing ; the skin tense and dry.
Twentieth day. Much rambling followed by recovery of reason ; speechless ; respiration short.
Twenty-first day. Death.
The respiration of this patient throughout was rare and large ; took no notice of anything ; she constantly wrapped herself up ; either much rambling or silence throughout.
CASE XVI
In Meliboea a youth took to his bed after being for a long time heated by drunkenness and sexual indulgence. He had shivering fits, nausea, sleeplessness, but no thirst.
First day. Copious, solid stools passed in abundance of fluid, and on the following days the excreta were copious, watery and of a greenish yellow. Urine thin, scanty and of no colour ; respiration rare and large with long intervals ; tension, soft underneath, of the hypochondrium, extending out to either side ; continual throbbing throughout of the epigastrium ; urine oily.
Tenth day. Delirious but quiet, for he was orderly and silent ; skin dry and tense ; stools either copious and thin or bilious and greasy. Fourteenth day. General exacerbation ; delirious with much wandering talk.
Twentieth day. Wildly out of his mind ; much tossing ; urine suppressed ; slight quantities of drink were retained.
Twenty-fourth day. Death.
Translated by Charles Darwin Adams
1. Those who composed what are called “The Cnidian Sentences” have described accurately what symptoms the sick experience in every disease, and how certain of them terminate; and in so far a man, even who is not a physician, might describe them correctly, provided he put the proper inquiries to the sick themselves what their complaints are. But those symptoms which the physician ought to know beforehand without being informed of them by the patient, are, for the most part, omitted, some in one case and some in others, and certain symptoms of vital importance for a conjectural judgment. But when, in addition to the diagnosis, they describe how each complaint should be treated, in these cases I entertain a still greater difference of opinion with them respecting the rules they have laid down; and not only do I not agree with them on this account, but also because the remedies they use are few in number; for, with the exception of acute diseases, the only medi-cines which they give are drastic purgatives, with whey, and milk at certain times. If, indeed, these remedies had been good and suitable to the complaints in which they are recommended, they would have been still more deserving of recommendation, if, while few in number, they were sufficient; but this is by no means the case. Those, indeed, who have remodeled these “Sentences” have treated of the remedies applicable in each complaint more in a medical fashion. But neither have the ancients written anything worth regimen, although this be a great omission. Some of them, indeed, were not ignorant of the many varieties of each complaint, and their manifold divisions, but when they wish to tell clearly the numbers (species?) of each disease they do not write for their species would be almost innumerable if every symptom experienced by the patients were held to constitute a disease, and receive a different name.
2. For my part, I approve of paying attention to everything relating to the art, and that those things which can be done well or properly should all be done properly; such as can be quickly done should be done quickly; such as can be neatly done should be done neatly; such operations as can be performed without pain should be done with the least possible pain; and that all other things of the like kind should be done better than they could be managed by the attendants. But I would more especially commend the physician who, in acute diseases, by which the bulk of mankind are cut off, conducts the treatment better than others. Acute diseases are those which the ancients named pleurisy, pneumonia, phrenitis, lethargy, causus, and the other diseases allied to these, including the continual fevers. For, unless when some general form of pestilential disease is epidemic, and diseases are sporadic and [not] of a similar character, there are more deaths from these diseases than from all the others taken together. The vulgar, indeed, do not recognize the difference between such physicians and their common attendants, and are rather disposed to commend and censure extraordinary remedies. This, then, is a great proof that the common people are most incompetent, of themselves, to form a judgment how such diseases should be treated: since persons who are not physicians pass for physicians owing most especially to these diseases, for it is an easy matter to learn the names of those things which are applicable to persons laboring under such complaints. For, if one names the juice of ptisan, and such and such a wine, and hydromel, the vulgar fancy that he prescribes exactly the same things as the physicians do, both the good and the bad, but in these matters there is a great difference between them.
3. But it appears to me that those things are more especially deserving of being consigned to writing which are undetermined by physicians, notwithstanding that they are of vital importance, and either do much good or much harm. By undetermined I mean such as these, wherefore certain physicians, during their whole lives, are constantly administering unstrained ptisans, and fancy they thus accomplish the cure properly, whereas others take great pains that the patient should not swallow a particle of the barley (thinking it would do much harm), but strain the juice through a cloth before giving it; others, again, will neither give thick ptisan nor the juice, some until the seventh day of the disease, and some until after the crisis. Physicians are not in the practice of mooting such questions; nor, perhaps, if mooted, would a solution of them be found; although the whole art is thereby exposed to much censure from the vulgar, who fancy that there really is no such science as medicine, since, in acute diseases, practitioners differ so much among themselves, that those things which one administers as thinking it the best that can be given, another holds to be bad; and, in this respect, they might say that the art of medicine resembles augury, since augurs hold that the same bird (omen) if seen on the left hand is good, but if on the right bad: and in divination by the inspection of entrails you will find similar differences; but certain diviners hold the very opposite of these opinions. I say, then, that this question is a most excellent one, and allied to very many others, some of the most vital importance in the Art, for that it can contribute much to the recovery of the sick, and to the preservation of health in the case of those who are well; and that it promotes the strength of those who use gymnastic exercises, and is useful to whatever one may wish to apply it.
4. Ptisan, then, appears to me to be justly preferred before all the other preparations from grain in these diseases, and I commend those who made this choice, for the mucilage of it is smooth, consistent, pleasant, lubricant, moderately diluent, quenches thirst if this be required, and has no astringency; gives no trouble nor swells up in the bowels, for in the boiling it swells up as much as it naturally can. Those, then, who make use of ptisan in such diseases, should never for a day allow their vessels to be empty of it, if I may say so, but should use it and not intermit, unless it be necessary to stop for a time, in order to administer medicine or a clyster. And to those who are accustomed to take two meals in the day it is to be given twice, and to those accustomed to live upon a single meal it is to be given once at first, and then, if the case permit, it is to be increased and given twice to them, if they appear to stand in need of it. At first it will be proper not to give a large quantity nor very thick, but in proportion to the quantity of food which one has been accustomed to take, and so as that the veins may not be much emptied. And, with regard to the augmentation of the dose, if the disease be of a drier nature than one had supposed, one must not give more of it, but should give before the draught of ptisan, either hydromel or wine, in as great quantity as may be proper; and what is proper in each case will be afterward stated by us. But if the mouth and the passages from the lungs be in a proper state as to moisture, the quantity of the draught is to be increased, as a general rule, for an early and abundant state of moisture indicates an early crisis, but a late and deficient moisture indicates a slower crisis. And these things are as I have stated for the most part; but many other things are omitted which are important to the prognosis, as will be explained afterwards. And the more that the patient is troubled with purging, in so much greater quantity is it to be given until the crisis, and moreover until two days beyond the crisis, in such cases as it appears to take place on the fifth, seventh, or ninth day, so as to have respect both for the odd and even day: after this the draught is to be given early in the day, and the other food in place is to be given in the evening. These things are proper, for the most part, to be given to those who, from the first, have used ptisan containing its whole substance; for the pains in pleuritic affections immediately cease of their own accord whenever the patients begin to expectorate anything worth mentioning, and the purgings become much better, and empyema much more seldom takes place, than if the patients used a different regimen, and the crises are more simple, occur earlier, and the cases are less subject to relapses.
5. Ptisans are to be made of the very best barley, and are to be well boiled, more especially if you do not intend to use them strained. For, besides the other virtues of ptisan, its lubricant quality prevents the barley that is swallowed from proving injurious, for it does not stick nor remain in the region of the breast; for that which is well boiled is very lubricant, excellent for quenching thirst, of very easy digestion, and very weak, all which qualities are wanted. If, then, one do not pay proper attention to the mode of administering the ptisan, much harm may be done; for when the food is shut up in the bowels, unless one procure some evacuation speedily, before administering the draught, the pain, if present, will be exasperated; and, if not present, it will be immediately created, and the respiration will become more frequent, which does mischief, for it dries the lungs, fatigues the hypochondria, the hypogastrium, and diaphragm. And moreover if, while the pain of the side persists, and does not yield to warm fomentations, and the sputa are not brought up, but are viscid and unconcocted, unless one get the pain resolved, either by loosening the bowels, or opening a vein, whichever of these may be proper;- if to persons so circumstanced ptisan be administered, their speedy death will be the result. For these reasons, and for others of a similar kind still more, those who use unstrained ptisan die on the seventh day, or still earlier, some being seized with delirium, and others dying suffocated with orthopnoee and riles. Such persons the ancients thought struck , for this reason more especially, that when dead the affected side was livid, like that of a person who had been struck. The cause of this is that they die before the pain is resolved, being seized with difficulty of respiration, and by large and rapid breathing, as has been already explained, the spittle becoming thick, acid, and unconcocted, cannot be brought up, but, being retained in the bronchi of the lungs, produces riles; and, when it has come to this, death, for the most part, is inevitable; for the sputa being retained prevent the breath from being drawn in, and force it speedily out, and thus the two conspire together to aggravate the sputa being retained renders the respiration frequent, while the respiration being frequent thickens the sputa, and prevents them from being evacuated. These symptoms supervene, not only if ptisan be administered unseasonably, but still more if any other food or drink worse than ptisan be given.
6. For the most part, then, the results are the same, whether the patient have used the unstrained ptisan or have used the juice alone; or even only drink; and sometimes it is necessary to proceed quite differently. In general, one should do thus: if fever commences shortly after taking food, and before the bowels have been evacuated, whether with or without pain, the physician ought to withhold the draught until he thinks that the food has descended to the lower part of the belly; and if any pain be present, the patient should use oxymel, hot if it is winter, and cold if it is summer; and, if there be much thirst, he should take hydromel and water. Then, if any pain be present, or any dangerous symptoms make their appearance, it will be proper to give the draught neither in large quantity nor thick, but after the seventh day, if the patient be strong. But if the earlier-taken food has not descended, in the case of a person who has recently swallowed food, and if he be strong and in the vigor of life, a clyster should be given, or if he be weaker, a suppository is to be administered, unless the bowels open properly of themselves. The time for administering the draught is to be particularly observed at the commencement and during the whole illness; when, then, the feet are cold, one should refrain from giving the ptisan, and more especially abstain from drink; but when the heat has descended to the feet, one may then give it; and one should look upon this season as of great consequence in all diseases, and not least in acute diseases, especially those of a febrile character, and those of a very dangerous nature. One may first use the juice, and then the ptisan, attending accurately to the rules formerly laid down.
7. When pain seizes the side, either at the commencement or at a later stage, it will not be improper to try to dissolve the pain by hot applications. Of hot applications the most powerful is hot water in a bottle, or bladder, or in a brazen vessel, or in an earthen one; but one must first apply something soft to the side, to prevent pain. A soft large sponge, squeezed out of hot water and applied, forms a good application; but it should be covered up above, for thus the heat will remain the longer, and at the same time the vapor will be prevented from being carried up to the patient’s breath, unless when this is thought of use, for sometimes it is the case. And further, barley or tares may be infused and boiled in diluted vinegar, stronger than that it could be drunk, and may then be sewed into bladders and applied; and one may bran in like manner. Salts or toasted millet in woolen bags are excellent for forming a dry fomentation, for the millet is light and soothing. A soft fomentation like this soothes pains, even such as shoot to the clavicle. Venesection, however, does not alleviate the pain unless when it extends to the clavicle. But if the pain be not dissolved by the fomentations, one ought not to foment for a length of time, for this dries the lungs and promotes suppuration; but if the pain point to the clavicle, or if there be a heaviness in the arm, or about the breast, or above the diaphragm, one should open the inner vein at the elbow, and not hesitate to abstract a large quantity, until it become much redder, or instead of being pure red, it turns livid, for both these states occur. But if the pain be below the diaphragm, and do not point to the clavicle, we must open the belly either with black hellebore or peplium, mixing the black hellebore with carrot or seseli, or cumin, or anise, or any other of the fragrant herbs; and with the peplium the juice of sulphium (asafoetida), for these substances, when mixed up together, are of a similar nature. The black hellebore acts more pleasantly and effectually than the peplium, while, on the other hand, the peplium expels wind much more effectually than the black hellebore, and both these stop the pain, and many other of the laxatives also stop it, but these two are the most efficacious that I am acquainted with. And the laxatives given in draughts are beneficial, when not very unpalatable owing to bitterness, or any other disagreeable taste, or from quantity, color, or any apprehension. When the patient has drunk the medicine, one ought to give him to swallow but little less of the ptisan than what he had been accustomed to; but it is according to rule not to give any draughts while the medicine is under operation; but when the purging is stopped then he should take a smaller draught than what he had been accustomed to, and afterwards go on increasing it progressively, until the pain cease, provided nothing else contra-indicate. This is my rule, also, if one would use the juice of ptisan (for I hold that it is better, on the whole, to begin with taking the decoction at once, rather than by first emptying the veins before doing so, or on the third, fourth, fifth, sixth, or seventh day, provided the disease has not previously come to a crisis in the course of this time), and similar preparations to those formerly described are to be made in those cases.
8. Such are the opinions which I entertain respecting the administering of the ptisan; and, as regards drinks, whichsoever of those about to be described may be administered, the same directions are generally applicable. And here I know that physicians are in the practice of doing the very reverse of what is proper, for they all wish, at the commencement of diseases, to starve their patients for two, three, or more days, and then to administer the ptisans and drinks; and perhaps it appears to them reasonable that, as a great change has taken place in the body, it should be counteracted by another great change. Now, indeed, to produce a change is no small matter, but the change must be effected well and cautiously, and after the change the administration of food must be conducted still more so. Those persons, then, would be most injured if the change is not properly managed, who used unstrained ptisans; they also would suffer who made use of the juice alone; and so also they would suffer who took merely drink, but these least of all.
9. One may derive information from the regimen of persons in good health what things are proper; for if it appear that there is a great difference whether the diet be so and so, in other respects, but more especially in the changes, how can it be otherwise in diseases, and more especially in the most acute? But it is well ascertained that even a faulty diet of food and drink steadily persevered in, is safer in the main as regards health than if one suddenly change it to another. Wherefore, in the case of persons who take two meals in the day, or of those who take a single meal, sudden changes induce suffering and weakness; and thus persons who have not been accustomed to dine, if they shall take dinner, immediately become weak, have heaviness over their whole body, and become feeble and languid, and if, in addition, they take supper, they will have acid eructations, and some will have diarrhoea whose bowels were previously dry, and not having been accustomed to be twice swelled out with food and to digest it twice a day, have been loaded beyond their wont. It is beneficial, in such cases, to counterbalance this change, for one should sleep after dinner, as if passing the night, and guard against cold in winter and heat in summer; or, if the person cannot sleep, he may stroll about slowly, but without making stops, for a good while, take no supper, or, at all events, eat little, and only things that are not unwholesome, and still more avoid drink, and especially water. Such a person will suffer still more if he take three full meals in the day, and more still if he take more meals; and yet there are many persons who readily bear to take three full meals in the day, provided they are so accustomed. And, moreover, those who have been in the habit of eating twice a day, if they omit dinner, become feeble and powerless, averse to all work, and have heartburn; their bowels seem, as it were, to hang loose, their urine is hot and green, and the excrement is parched; in some the mouth is bitter, the eyes are hollow, the temples throb, and the extremities are cold, and the most of those who have thus missed their dinner cannot eat supper; or, if they do sup, they load their stomach, and pass a much worse night than if they had previously taken dinner. Since, then, an unwonted change of diet for half a day produces such effects upon persons in health, it appears not to be a good thing either to add or take from. If, then, he who was restricted to a single meal, contrary to usage, having his veins thus left empty during a whole day, when he supped according to custom felt heavy, it is probable that if, because he was uneasy and weak from the want of dinner, he took a larger supper than wont, he would be still more oppressed; or if, wanting food for a still greater interval, he suddenly took a meal after supper, he will feel still greater oppression. He, then, who, contrary to usage, has had his veins kept empty by want of food, will find it beneficial to counteract the bad effects during that day as follows: let him avoid cold, heat, and exertion, for he could bear all these ill; let him make his supper considerably less than usual, and not of dry food, but rather liquid; and let him take some drink, not of a watery character, nor in smaller quantity than is proportionate to the food, and on the next day he should take a small dinner, so that, by degrees, he may return to his former practice. Persons who are bilious in the stomach bear these changes worst, while those who are pituitous, upon the whole, bear the want of food best, so that they suffer the least from being restricted to one meal in the day, contrary to usage. This, then, is a sufficient proof that the greatest changes as to those things which regard our constitutions and habits are most especially concerned in the production of diseases, for it is impossible to produce unseasonably a great emptying of the vessels by abstinence, or to administer food while diseases are at their acme, or when inflammation prevails; nor, on the whole, to make a great change either one way or another with impunity.
10. One might mention many things akin to these respecting the stomach and bowels, to show how people readily bear such food as they are accustomed to, even if it is not naturally good, and drink in like manner, and how they bear unpleasantly such food as they are not accustomed to, even although not bad, and so in like manner with drink; and as to the effects of eating much flesh, contrary to usage, or garlic, or asafoetida, or the stem of the plant which produces it, or things of a similar kind possessed of strong properties, one would be less surprised if such things produce pains in the bowels, but rather when one learned what trouble, swelling, flatulence, and tormina the cake (maza) will raise in the belly when eaten by a person not accustomed to it; and how much weight and distention of the bowels bread will create to a person accustomed to live upon the maza; and what thirst and sudden fullness will be occasioned by eating hot bread, owing to its desiccant and indigestible properties; and what different effects are produced by fine and coarse bread when eaten contrary to usage, or by the cake when usually dry, moist, or viscid; and what different effects polenta produces upon those who are accustomed and those who are unaccustomed to the use of it; or drinking of wine or drinking of water, when either custom is suddenly exchanged for the other; or when, contrary to usage, diluted wine or undiluted has been suddenly drunk, for the one will create water-brash in the upper part of the intestinal canal and flatulence in the lower, while the other will give rise to throbbing of the arteries, heaviness of the head, and thirst; and white and dark-colored wine, although both strong wines, if exchanged contrary to usage, will produce very different effects upon the body, so that one need the less wonder that a sweet and strong wine, if suddenly exchanged, should have by no means the same effect.
11. Let us here briefly advert to what may be said on the opposite side; namely, that a change of diet has occurred in these cases, without any change in their body, either as to strength, so as to require an increase of food, or as to weakness, so as to require a diminution. But the strength of the patient is to be taken into consideration, and the manner of the disease, and of the constitution of the man, and the habitual regimen of the patient, not only as regards food but also drink. Yet one must much less resort to augmentation, since it is often beneficial to have recourse to abstraction, when the patient can bear it, until the disease having reached its acme and has become concocted. But in what cases this must be done will be afterwards described. One might write many other things akin to those which have been now said, but there is a better proof, for it is not akin to the matter on which my discourse has principally turned, but the subject-matter itself is a most seasonable proof. For some at the commencement of acute diseases have taken food on the same day, some on the next day; some have swallowed whatever has come in their way, and some have taken cyceon . Now all these things are worse than if one had observed a different regimen; and yet these mistakes, committed at that time, do much less injury than if one were to abstain entirely from food for the first two or three days, and on the fourth or fifth day were to take such food; and it would be still worse, if one were to observe total abstinence for all these days, and on the following days were to take such a diet, before the disease is concocted; for in this way death would be the consequence to most people, unless the disease were of a very mild nature. But the mistakes committed at first were not so irremediable as these, but could be much more easily repaired. This, therefore, I think a strong proof that such or such a draught need not be prescribed on the first days to those who will use the same draughts afterwards. At the bottom, therefore, they do not know, neither those using unstrained ptisans, that they are hurt by them, when they begin to swallow them, if they abstain entirely from food for two, three, or more days; nor do those using the juice know that they are injured in swallowing them, when they do not commence with the draught seasonably. But this they guard against, and know that it does much mischief, if, before the disease be concocted, the patient swallow unstrained ptisan, when accustomed to use strained. All these things are strong proofs that physicians do not conduct the regimen of patients properly, but that in those diseases in which total abstinence from food should not be enforced on patients that will be put on the use of ptisans, they do enforce total abstinence; that in those cases in which there should be no change made from total abstinence to ptisans, they do make the change; and that, for the most part, they change from abstinence to ptisans, exactly at the time when it is often beneficial to proceed from ptisans almost to total abstinence, if the disease happen to be in the state of exacerbation. And sometimes crude matters are attracted from the head, and bilious from the region near the chest, and the patients are attacked with insomnolency, so that the disease is not concocted; they become sorrowful, peevish, and delirious; there are flashes of light in their eyes, and noises in their ears; their extremities are cold, their urine unconcocted; the sputa thin, saltish, tinged with an intense color and smell; sweats about the neck, and anxiety; respiration, interrupted in the expulsion of the air, frequent and very large; expression of the eyelids dreadful; dangerous deliquia ; tossing of the bed-clothes from the breast; the hands trembling, and sometimes the lower lip agitated. These symptoms, appearing at the commencement, are indicative of strong delirium, and patients so affected generally die, or if they escape, it is with a deposit, hemorrhage from the nose, or the expectoration of thick matter, and not otherwise. Neither do I perceive that physicians are skilled in such things as these; how they ought to know such diseases as are connected with debility, and which are further weakened by abstinence from food, and those aggravated by some other irritation; those by pain, and from the acute nature of the disease, and what affections and various forms thereof our constitution and habit engender, although the knowledge or ignorance of such things brings safety or death to the patient. For it is a great mischief if to a patient debilitated by pain, and the acute nature of the disease, one administer drink, or more ptisan, or food, supposing that the debility proceeds from inanition. It is also disgraceful not to recognize a patient whose debility is connected with inanition, and to pinch him in his diet; this mistake, indeed, is attended with some danger, but much less than the other, and yet it is likely to expose one to much greater derision, for if another physician, or a private person, coming in and knowing what has happened, should give to eat or drink those things which the other had forbidden, the benefit thus done to the patient would be manifest. Such mistakes of practitioners are particularly ridiculed by mankind, for the physician or nonprofessional man thus coming in, seems as it were to resuscitate the dead. On this subject I will describe elsewhere the symptoms by which each of them may be recognized.
12. And the following observations are similar to those now made respecting the bowels. If the whole body rest long, contrary to usage, it does not immediately recover its strength; but if, after a protracted repose, it proceed to labor, it will clearly expose its weakness. So it is with every one part of the body, for the feet will make a similar display, and any other of the joints, if, being unaccustomed to labor, they be suddenly brought into action, after a time. The teeth and the eyes will suffer in like manner, and also every other part whatever. A couch, also, that is either softer or harder than one has been accustomed to will create uneasiness, and sleeping in the open air, contrary to usage, hardens the body. But it is sufficient merely to state examples of all these cases. If a person having received a wound in the leg, neither very serious nor very trifling, and he being neither in a condition very favorable to its healing nor the contrary, at first betakes himself to bed, in order to promote the cure, and never raises his leg, it will thus be much less disposed to inflammation, and be much sooner well, than it would have been if he had strolled about during the process of healing; but if upon the fifth or sixth day, or even earlier, he should get up and attempt to walk, he will suffer much more then than if he had walked about from the commencement of the cure, and if he should suddenly make many laborious exertions, he will suffer much more than if, when the treatment was conducted otherwise, he had made the same exertions on the same days. In fine, all these things concur in proving that all great changes, either one way or another, are hurtful. Wherefore much mischief takes place in the bowels, if from a state of great inanition more food than is moderate be administered (and also in the rest of the body, if from a state of great rest it be hastily brought to greater exertion, it will be much more injured), or if from the use of much food it be changed to complete abstinence, and therefore the body in such cases requires protracted repose, and if, from a state of laborious exertion, the body suddenly falls into a state of ease and indolence, in these cases also the bowels would require continued repose from abundance of food, for otherwise it will induce pain and heaviness in the whole body.
13. The greater part of my discourse has related to changes, this way or that. For all purposes it is profitable to know these things, and more especially respecting the subject under consideration,- that in acute diseases, in which a change is made to ptisans from a state of inanition, it should be made as I direct; and then that ptisans should not be used until the disease be concocted, or some other symptom, whether of evacuation or of irritation, appear in the intestines, or in the hypochondria, such as will be described. Obstinate insomnolency impairs the digestion of the food and drink, and in other respects changes and relaxes the body, and occasions a heated state, and heaviness of the head.
14. One must determine by such marks as these, when sweet, strong, and dark wine, hydromel, water and oxymel, should be given in acute diseases. Wherefore the sweet affects the head less than the strong, attacks the brain less, evacuates the bowels more than the other, but induces swelling of the spleen and liver; it does not agree with bilious persons, for it causes them to thirst; it creates flatulence in the upper part of the intestinal canal, but does not disagree with the lower part, as far as regards flatulence; and yet flatulence engendered by sweet wine is not of a transient nature, but rests for a long time in the hypochondria. And therefore it in general is less diuretic than wine which is strong and thin; but sweet wine is more expectorant than the other. But when it creates thirst, it is less expectorant in such cases than the other wine, but if it do not create thirst, it promotes expecto-ration better than the other. The good and bad effects of a white, strong wine, have been already frequently and fully stated in the disquisition on sweet wine; it is determined to the bladder more than the other, is diuretic and laxative, and should be very useful in such complaints; for if in other respects it be less suitable than the other, the clearing out of the bladder effected by it is beneficial to the patient, if properly administered. There are excellent examples of the beneficial and injurious effects of wine, all which were left undetermined by my predecessors. In these diseases you may use a yellow wine, and a dark austere wine for the following purposes: if there be no heaviness of the head, nor delirium, nor stoppage of the expectoration, nor retention of the urine, and if the alvine discharges be more loose and like scrapings than usual, in such cases a change from a white wine to such as I have mentioned, might be very proper. It deserves further to be known, that it will prove less injurious to all the parts above, and to the bladder, if it be of a more watery nature, but that the stronger it is, it will be the more beneficial to the bowels.
15. Hydromel, when drunk in any stage of acute disease, is less suitable to persons of a bilious temperament, and to those who have enlarged viscera, than to those of a different character; it increases thirst less than sweet wine; it softens the lungs, is moderately expectorant, and alleviates a cough; for it has some detergent quality in it, whence it lubricates the sputum. Hydromel is also moderately diuretic, unless prevented by the state of any of the viscera. And it also occasions bilious discharges downwards, sometimes of a proper character, and sometimes more intense and frothy than is suitable; but such rather occurs in persons who are bilious, and have enlarged viscera. Hydromel rather produces expectoration, and softening of the lungs, when given diluted with water. But unmixed hydromel, rather than the diluted, produces frothy evacuations, such as are unseasonably and intensely bilious, and too hot; but such an evacuation occasions other great mischiefs, for it neither extinguishes the heat in the hypochondria, but rouses it, induces inquietude, and jactitation of the limbs, and ulcerates the intestines and anus. The remedies for all these will be described afterwards. By using hydromel without ptisans, instead of any other drink, you will generally succeed in the treatment of such diseases, and fail in few cases; but in what instances it is to be given, and in what it is not to be given, and wherefore it is not to be given,- all this has been explained already, for the most part. Hydromel is generally condemned, as if it weakened the powers of those who drink it, and on that account it is supposed to accelerate death; and this opinion arose from persons who starve themselves to death, some of whom use hydromel alone for drink, as fancying that it really has this effect. But this is by no means always the case. For hydromel, if drunk alone, is much stronger than water, if it do not disorder the bowels; but in some respects it is stronger, and in some weaker, than wine that is thin, weak, and devoid of bouquet . There is a great difference between unmixed wine and unmixed honey, as to their nutritive powers, for if a man will drink double the quantity of pure wine, to a certain quantity of honey which is swallowed, he will find himself much stronger from the honey, provided it do not disagree with his bowels, and that his alvine evacuations from it will be much more copious. But if he shall use ptisan for a draught, and drink afterward hydromel, he will feel full, flatulent, and uncomfortable in the viscera of the hypochondrium; but if the hydromel be taken before the draught, it will not have the same injurious effects as if taken after it, but will be rather beneficial. And boiled hydromel has a much more elegant appearance than the unboiled, being clear, thin, white, and transparent, but I am unable to mention any good quality which it possesses that the other wants. For it is not sweeter than the unboiled, provided the honey be fine, and it is weaker, and occasions less copious evacuations of the bowels, neither of which effects is required from the hydromel. But one should by all means use it boiled, provided the honey be bad, impure, black, and not fragrant, for the boiling will remove the most of its bad qualities and appearances.
16. You will find the drink, called oxymel, often very useful in these complaints, for it promotes expectoration and freedom of breathing. the following are the proper occasions for administering it. When strongly acid it has no mean operation in rendering the expectoration more easy, for by bringing up the sputa, which occasion troublesome hawking, and rendering them more slippery, and, as it were, clearing the windpipe with a feather, it relieves the lungs and proves emollient to them; and when it succeeds in producing these effects it must do much good. But there are cases in which hydromel, strongly acid, does not promote expectoration, but renders it more viscid and thus does harm, and it is most apt to produce these bad effects in cases which are otherwise of a fatal character, when the patient is unable to cough or bring up the sputa. On this account, then, one ought to consider beforehand the strength of the patient, and if there be any hope, then one may give it, but if given at all in such cases it should be quite tepid, and in by no means large doses. But if slightly acrid it moistens the mouth and throat, promotes expectoration, and quenches thirst; agrees with the viscera seated in the hypochondrium, and obviates the bad effects of the honey; for the bilious quality of the honey is thereby corrected. It also promotes flatulent discharges from the bowels, and is diuretic, but it occasions watery discharges and those resembling scrapings, from the lower part of the intestine, which is sometimes a bad thing in acute diseases, more especially when the flatulence cannot be passed, but rolls backwards; and otherwise it diminishes the strength and makes the extremities cold, this is the only bad effect worth mentioning which I have known to arise from the oxymel. It may suit well to drink a little of this at night before the draught of ptisan, and when a considerable interval of time has passed after the draught there will be nothing to prevent its being taken. But to those who are restricted entirely to drinks without draughts of ptisan, it will therefore not be proper at all times to give it, more especially from the fretting and irritation of the intestine which it occasions, (and these bad effects it will be the more apt to produce provided there be no faeces in the intestines and the patient is laboring under inanition,) and then it will weaken the powers of the hydromel. But if it appears advantageous to use a great deal of this drink during the whole course of the disease, one should add to it merely as much vinegar as can just be perceived by the taste, for thus what is prejudicial in it will do the least possible harm, and what is beneficial will do the more good. In a word, the acidity of vinegar agrees rather with those who are troubled with bitter bile, than with those patients whose bile is black; for the bitter principle is dissolved in it and turned to phlegm, by being suspended in it; whereas black bile is fermented, swells up, and is multiplied thereby: for vinegar is a melanogogue. Vinegar is more prejudicial to women than to men, for it creates pains in the uterus.
17. I have nothing further to add as to the effects of water when used as a drink in acute diseases; for it neither soothes the cough in pneumonia, nor promotes expectoration, but does less than the others in this respect, if used alone through the whole complaint. But if taken intermediate between oxymel and hydromel, in small quantity, it promotes expectoration from the change which it occasions in the qualities of these drinks, for it produces, as it were, a certain overflow. Otherwise it does not quench the thirst, for it creates bile in a bilious temperament, and is injurious to the hypochondrium; and it does the most harm, engenders most bile, and does the least good when the bowels are empty; and it increases the swelling of the spleen and liver when they are in an inflamed state; it produces a gurgling noise in the intestines and swims on the stomach; for it passes slowly downwards, as being of a coldish and indigestible nature, and neither proves laxative nor diuretic; and in this respect, too, it proves prejudicial, that it does not naturally form does in the intestines: and, if it be drunk while the feet are cold, its injurious effects will be greatly aggravated, in all those parts to which it may be determined. When you suspect in these diseases either strong heaviness of the head, or mental alienation, you must abstain entirely from wine, and in this case use water, or give weak, straw-colored wine, entirely devoid of bouquet , after which a little water is to be given in addition; for thus the strength of the will less affect the head and the understanding: but in which cases water is mostly to be given for drink, when in large quantity, when in moderate, when cold, and when hot; all these things have either been discussed already or will be treated of at the proper time. In like manner, with respect to all the others, such as barley-water, the drinks made from green shoots, those from raisins, and the skins of grapes and wheat, and bastard saffron, and myrtles, pomegranates, and the others, when the proper time for using them is come, they will be treated of along with the disease in question, in like manner as the other compound medicines.
18. The bath is useful in many diseases, in some of them when used steadily, and in others when not so. Sometimes it must be less used than it would be otherwise, from the want of accommodation; for in few families are all the conveniences prepared, and persons who can manage them as they ought to be. And if the patient be not bathed properly, he maybe thereby hurt in no inconsiderable degree, for there is required a place to cover him that is free of smoke, abundance of water, materials for frequent baths, but not very large, unless this should be required. It is better that no friction should be applied, but if so, a hot soap ( smegma ) must be used in greater abundance than is common, and an affusion of a considerable quantity of water is to be made at the same time and afterwards repeated. There must also be a short passage to the basin, and it should be of easy ingress and egress. But the person who takes the bath should be orderly and reserved in his manner, should do nothing for himself, but others should pour the water upon him and rub him, and plenty of waters, of various temperatures, should be in readiness for the douche , and the affusions quickly made; and sponges should be used instead of the comb ( strigil ), and the body should be anointed when not quite dry. But the head should be rubbed by the sponge until it is quite dry; the extremities should be protected from cold, as also the head and the rest of the body; and a man should not be washed immediately after he has taken a draught of ptisan or a drink; neither should he take ptisan as a drink immediately after the bath. Much will depend upon whether the patient, when in good health, was very fond of the bath, and in the custom of taking it: for such persons, especially, feel the want of it, and are benefited if they are bathed, and injured if they are not. In general it suits better with cases of pneumonia than in ardent fevers; for the bath soothes the pain in the side, chest, and back; concocts the sputa, promotes expectoration, improves the respiration, and allays lassitude; for it soothes the joints and outer skin, and is diuretic, removes heaviness of the head, and moistens the nose. Such are the benefits to be derived from the bath, if all the proper requisites be present; but if one or more of these be wanting, the bath, instead of doing good, may rather prove injurious; for every one of them may do harm if not prepared by the attendants in the proper manner. It is by no means a suitable thing in these diseases to persons whose bowels are too loose, or when they are unusually confined, and there has been no previous evacuation; neither must we bathe those who are debilitated, nor such as have nausea or vomiting, or bilious eructations; nor such as have hemorrhage from the nose, unless it be less than required at that stage of the disease (with those stages you are acquainted), but if the discharge be less than proper, one should use the bath, whether in order to benefit the whole body or the head alone. If then the proper requisites be at hand, and the patient be well disposed to the bath, it may be administered once every day, or if the patient be fond of the bath there will be no harm, though he should take it twice in the day. The use of the bath is much more appropriate to those who take unstrained ptisan, than to those who take only the juice of it, although even in their case it may be proper; but least of all does it suit with those who use only plain drink, although, in their case too it may be suitable; but one must form a judgment from the rules laid down before, in which of these modes of regimen the bath will be beneficial, and in which not. Such as want some of the requisites for a proper bath, but have those symptoms which would be benefited by it, should be bathed; whereas those who want none of the proper requisites, but have certain symptoms which contraindicate the bath, are not to be bathed.
APPENDIX
1. Ardent fever (causus) takes place when the veins, being dried up in the summer season, attract acrid and bilious humors to themselves; and strong fever seizes the whole body, which experiences aches of the bones, and is in a state of lassitude and pain. It takes place most commonly from a long walk and protracted thirst, when the veins being dried up attract acrid and hot defluxions to themselves. The tongue becomes rough, dry, and very black; there are gnawing pains about the bowels; the alvine discharges are watery and yellow; there is intense thirst, insomnolency, and sometimes wandering of the mind. To a person in such a state give to drink water and as much boiled hydromel of a watery consistence as he will take; and if the mouth be bitter, it may be advantageous to administer an emetic and clyster; and if these things do not loosen the bowels, purge with the boiled milk of asses. Give nothing saltish nor acrid, for they will not be borne; and give no draughts of ptisan until the crisis be past. And the affection is resolved if there be an epistaxis, or if true critical sweats supervene with urine having white, thick, and smooth sediments, or if a deposit take place anywhere; but if it be resolved without these, there will be a relapse of the complaint, or pain in the hips and legs will ensue, with thick sputa, provided the patient be convalescent. Another species of ardent fever: belly loose, much thirst, tongue rough, dry, and saltish, retention of urine, insomnolency, extremities cold. In such a case, unless there be a flow of blood from the nose, or an abscess form about the neck, or pain in the limbs, or the patient expectorate thick sputa (these occur when the belly is constipated), or pain of the hips, or lividity of the genital organs, there is no crisis; tension of the testicle is also a critical symptom. Give attractive draughts.
2. Bleed in the acute affections, if the disease appear strong, and the patients be in the vigor of life, and if they have strength. If it be quinsy or any other of the pleuritic affections, purge with electuaries; but if the patient be weaker, or if you abstract more blood, you may administer a clyster every third day, until he be out of danger, and enjoin total abstinence if necessary.
3. Hypochondria inflamed not from retention of flatus, tension of the diaphragm, checked respiration, with dry orthopnoea, when no pus is formed, but when these complaints are connected with obstructed respiration; but more especially strong pains of the liver, heaviness of the spleen, and other phlegmasiae and in-tense pains above the diaphragm, diseases connected with collections of humors,- all these diseases do not admit of resolution, if treated at first by medicine, but venesection holds the first place in conducting the treatment; then we may have recourse to a clyster, unless the disease be great and strong; but if so, purging also may be necessary; but bleeding and purging together require caution and moderation. Those who attempt to resolve inflammatory diseases at the commencement by the administration of purgative medicines, remove none of the morbific humors which produce the inflammation and tension; for the diseases while unconcocted could not yield, but they melt down those parts which are healthy and resist the disease; so when the body is debilitated the malady obtains the mastery; and when the disease has the upper hand of the body, it does not admit of a cure.
4. When a person suddenly loses his speech, in connection with obstruction of the veins,- if this happen without warning or any other strong cause, one ought to open the internal vein of the right arm, and abstract blood more or less according to the habit and age of the patient. Such cases are mostly attended with the following symptoms: redness of the face, eyes fixed, hands distended, grinding of the teeth, palpitations, jaws fixed, coldness of the extremities, retention of airs in the veins.
5. When pains precede, and there are influxes of black bile and of acrid humors, and when by their pungency the internal parts are pained, and the veins being pinched and dried become distended, and getting inflamed attract the humors running into the parts, whence the blood being vitiated, and the airs collected there not being able to find their natural passages, coldness comes on in consequence of this stasis, with vertigo, loss of speech, heaviness of the head, and convulsion, if the disease fix on the liver, the heart, or the great vein (vena cava?); whence they are seized with epilepsy or apoplexy, if the defluxions fall upon the containing parts, and if they are dried up by airs which cannot make their escape; such persons having been first tormented are to be immediately bled at the commencement, while all the peccant vapors and humors are buoyant, for then the cases more easily admit of a cure; and then supporting the strength and attending to the crisis, we may give emetics, unless the disease be alleviated; or if the bowels be not moved, we may administer a clyster and give the boiled milk of asses, to the amount of not less than twelve heminae, or if the strength permit, to more than sixteen.
6. Quinsy takes place when a copious and viscid defluxion from the head, in the season of winter or spring, flows into the jugular veins, and when from their large size they attract a greater defluxion; and when owing to the defluxion being of a cold and viscid nature it becomes enfarcted, obstructing the passages of the respiration and of the blood, coagulates the surrounding blood, and renders it motionless and stationary, it being naturally cold and disposed to obstructions. Hence they are seized with convulsive suffocation, the tongue turning livid, assuming a rounded shape, and being vent owing to the veins which are seated below the tongue (for when an enlarged uvula, which is called uva , is cut, a large vein may be observed on each side). These veins, then, becoming filled, and their roots extending into the tongue, which is of a loose and spongy texture, it, owing to its dryness receiving forcibly the juice from the veins, changes from broad and becomes round, its natural color turns to livid, from a soft consistence it grows hard, instead of being flexible it becomes inflexible, so that the patient would soon be suffocated unless speedily relieved. Bleeding, then, in the arm, and opening the sublingual veins, and purging with the electuaries, and giving warm gargles, and shaving the head, we must apply to it and the neck a cerate, and wrap them round with wool, and foment with soft sponges squeezed out of hot water; give to drink water and hydromel, not cold; and administer the juice of ptisan when, having passed the crisis, the patient is out of danger. When, in the season of summer or autumn, there is a hot and nitrous defluxion from the head (it is rendered hot and acrid by the season), being of such a nature it corrodes and ulcerates, and fills with air, and orthopnoea attended with great dryness supervenes; the fauces, when examined, do not seem swollen; the tendons on the back part of the neck are contracted, and have the appearance as if it were tetanus; the voice is lost, the breathing is small, and inspiration becomes frequent and laborious. In such persons the trachea becomes ulcerated, and the lungs engorged, from the patient’s not being able to draw in the external air. In such cases, unless there be a spontaneous determination to the external parts of the neck, the symptoms become still more dreadful, and the danger more imminent, partly owing to the season, and the hot and acrid humors which cause the disease.
7. When fever seizes a person who has lately taken food, and whose bowels are loaded with faeces which have been long retained, whether it be attended with pain of the side or not, he ought to lie quiet until the food descend to the lower region of the bowels, and use oxymel for drink; but when the load descends to the loins, a clyster should be administered, or he should be purged by medicine; and when purged, he should take ptisan for food and hydromel for drink; then he may take the cerealia, and boiled fishes, and a watery wine in small quantity, at night, but during the day, a watery hydromel. When the flatus is offensive, either a suppository or clyster is to be administered; but otherwise the oxymel is to be discontinued, until the matters descend to the lower part of the bowels, and then they are to be evacuated by a clyster. But if the ardent fever (causus) supervene when the bowels are empty, should you still judge it proper to administer purgative medicine, it ought not be done during the first three days, nor earlier than the fourth. When you give the medicine, use the ptisan, observing the paroxysms of the fevers, so as not to give it when the fever is setting in, but when it is ceasing, or on the decline, and as far as possible from the commencement. When the feet are cold, give neither drink nor ptisan, nor anything else of the kind, but reckon it an important rule to refrain until they become warm, and then you may administer them with advantage. For the most part, coldness of the feet is a symptom of a paroxysm of the fever coming on; and if at such a season you apply those things, you will commit the greatest possible mistake, for you will augment the disease in no small degree. But when the fever ceases, the feet, on the contrary, become hotter than the rest of the body; for when the heat leaves the feet, it is kindled up in the breast, and sends its flame up to the head. And when all the heat rushes upwards, and is exhaled at the head, it is not to be wondered at that the feet become cold, being devoid of flesh, and tendinous; and besides, they contract cold, owing to their distance from the hotter parts of the body, an accumulation of heat having taken place in the chest: and again, in like manner, when the fever is resolved and dissipated, the heat descends to the feet, and, at the same time, the head and chest become cold. Wherefore one should attend to this; that when the feet are cold, the bowels are necessarily hot, and filled with nauseous matters; the hypochondrium distended: there is jactitation of the body, owing to the internal disturbance; and aberration of the intellect, and pains; the patient is agitated, and wishes to vomit, and if he vomits bad matters he is pained; but when the heat descends to the feet, and the urine passes freely, he is every way lightened, even although he does not sweat; at this season, then, the ptisan ought to be given; it would be death to give it before.
8. When the bowels are loose during the whole course of fevers, in this case we are most especially to warm the feet, and see that they are properly treated with cerates, and wrapped in shawls, so that they may not become colder than the rest of the body; but when they are hot, no fomentation must be made to them, but care is to be taken that they do not become cold; and very little drink is to be used, either cold water or hydromel. In those cases of fever where the bowels are loose, and the mind is disordered, the greater number of patients pick the wool from their blankets, scratch their noses, answer briefly when questions are put to them, but, when left to themselves, utter nothing that is rational. Such attacks appear to me to be connected with black bile. When in these cases there is a colliquative diarrhoea, I am of opinion that we ought to give the colder and thicker ptisans, and that the drinks ought to be binding, of a vinous nature, and rather astringent. In cases of fever attended from the first with vertigo, throbbing of the head, and thin urine, you may expect the fever to be exacerbated at the crisis; neither need it excite wonder, although there be delirium. When, at the commencement, the urine is cloudy or thick, it is proper to purge gently, provided this be otherwise proper; but when the urine at first is thin, do not purge such patients, but, if thought necessary, give a clyster; such patients should be thus treated; they should be kept in a quiet state, have unguents applied to them, and be covered up properly with clothes, and they should use for drink a watery hydromel, and the juice of ptisan as a draught in the evening; clear out the bowels at first with a clyster, but give no purgative medicines to them, for, if you move the bowels strongly, the urine is not concocted, but the fever remains long, without sweats and without a crisis. Do not give draughts when the time of the crisis is at hand, if there be agitation, but only when the fever abates and is alleviated. It is proper to be guarded at the crises of other fevers, and to withhold the draughts at that season. Fevers of this description are apt to be protracted, and to have determinations, if the inferior extremities be cold, about the ears and neck, or, if these parts are not cold, to have other changes; they have epistaxis, and disorder of the bowels. But in cases of fever attended with nausea, or distention of the hypochondria, when the patients cannot lie reclined in the same position, and the extremities are cold, the greatest care and precaution are necessary; nothing should be given to them, except oxymel diluted with water; no draught should be administered, until the fever abate and the urine be concocted; the patient should be laid in a dark apartment, and recline upon the softest couch, and he should be kept as long as possible in the same position, so as not to toss about, for this is particularly beneficial to him. Apply to the hypochondrium linseed by inunctions, taking care that he do not catch cold when the application is made; let it be in a tepid state, and boiled in water and oil. One may judge from the urine what is to take place, for if the urine be thicker, and more yellowish, so much the better; but if it be thinner, and blacker, so much the worse; but if it undergo changes, it indicates a prolongation of the disease, and the patient, in like manner, must experience a change to the worse and the better. Irregular fevers should be let alone until they become settled, and, when they do settle, they are to be treated by a suitable diet and medicine, attending to the constitution of the patient.
9. The aspects of the sick are various; wherefore the physician should pay attention, that he may not miss observing the exciting causes, as far as they can be ascertained by reasoning, nor such symptoms as should appear on an even or odd day, but he ought to be particularly guarded in observing the odd days, as it is in them, more especially, that changes take place in patients. He should mark, particularly, the first day on which the patient became ill, considering when and whence the disease commenced, for this is of primary importance to know. When you examine the patient, inquire into all particulars; first how the head is, and if there be no headache, nor heaviness in it; then examine if the hypochondria and sides be free of pain; for if the hypochondrium be painful, swelled, and unequal, with a sense of satiety, or if there be pain in the side, and, along with the pain, either cough, tormina, or belly-ache, if any of these symptoms be present in the hypochondrium, the bowels should be opened with clysters, and the patient should drink boiled hydromel in a hot state. The physician should ascertain whether the patient be apt to faint when he is raised up, and whether his breathing be free; and examine the discharges from the bowels, whether they be very black, or of a proper color, like those of persons in good health, and ascertain whether the fever has a paroxysm every third day, and look well to such persons on those days. And should the fourth day prove like the third, the patient is in a dangerous state. With regard to the symptoms, black stools prognosticate death; but if they resemble the discharges of a healthy person, and if such is their appearance every day, it is a favorable symptom; but when the bowels do not yield to a suppository, and when, though the respiration be natural, the patient when raised to the night table, or even in bed, be seized with deliquium, you may expect that the patient, man or woman, who experiences these symptoms, is about to fall into a state of delirium. Attention also should be paid to the hands, for if they tremble, you may expect epistaxis; and observe the nostrils, whether the breath be drawn in equally by both; and if expiration by the nostrils be large, a convulsion is apt to take place; and should a convulsion occur to such a person, death may be anticipated, and it is well to announce it beforehand.
10. If, in a winter fever, the tongue be rough, and if there be swoonings, it is likely to be the remission of the fever. Nevertheless such a person is to be kept upon a restricted diet, with water for drink, and hydromel, and the strained juices, not trusting to the remission of the fevers, as persons having these symptoms are in danger of dying; when, therefore, you perceive these symptoms, announce this prognostic, if you shall judge proper, after making the suitable observations. When, in fevers, any dangerous symptom appears on the fifth day, when watery discharges suddenly take place from the bowels, when deliquium animi occurs, or the patient is attacked with loss of speech, convulsions, or hiccup, under such circumstances he is likely to be affected with nausea, and sweats break out under the nose and forehead, or on the back part of the neck and head, and patients with such symptoms shortly die, from stoppage of the respiration. When, in fevers, abscesses form about the legs, and, getting into a chronic state, are not concocted while the fever persists, and if one is seized with a sense of suffocation in the throat, while the fauces are not swelled, and if it do not come to maturation, but is repressed, in such a case there is apt to be a flow of blood from the nose; if this, then, be copious, it indicates a resolution of the disease, but if not, a prolongation of the complaint; and the less the discharge, so much worse the symptoms, and the more protracted the disease; but if the other symptoms are very favorable, expect in such a case that pains will fall upon the feet; if then they attack the feet, and if these continue long in a very painful, and inflamed state, and if there be no resolution, the pains will extend by degrees to the neck, to the clavicle, shoulder, breast, or to some articulation, in which an inflammatory tumor will necessarily form. When these are reduced, if the hands are contracted, and become trembling, convulsion and delirium seize such a person; but blisters break out on the eyebrow, erythema takes place, the one eyelid being tumefied overtops the other, a hard inflammation sets in, the eye become strongly swelled, and the delirium increases much, but makes its attacks rather at night than by day. These symptoms more frequently occur on odd than on even days, but, whether on the one or the other, they are of a fatal character. Should you determine to give purgative medicines in such cases, at the commencement, you should do so before the fifth day, if there be borborygmi in the bowels, or, if not, you should omit the medicines altogether. If there be borborygmi, with bilious stools, purge moderately with scammony; but with regard to the treatment otherwise, administer as few drinks and draughts as until there be some amendment, and the disease is past the fourteenth day. When loss of speech seizes a person, on the fourteenth day of a fever, there is not usually a speedy resolution, nor any removal of the disease, for this symptom indicates a protracted disease; and when it appears on that day, it will be still more prolonged. When, on the fourth day of a fever, the tongue articulates confusedly, and when there are watery and bilious discharges from the bowels, such a patient is apt to fall into a state of delirium; the physician ought, therefore, to watch him, and attend to whatever symptoms may turn up. In the season of summer and autumn an epistaxis, suddenly occurring in acute diseases, indicates vehemence of the attack, and inflammation in the course of the veins, and on the day following, the discharge of thin urine; and if the patient be in the prime of life, and if his body be strong from exercise, and brawny, or of a melancholic temperament, or if from drinking has trembling hands, it may be well to announce beforehand either delirium or convulsion; and if these symptoms occur on even days, so much the better; but on critical days, they are of a deadly character. If, then, a copious discharge of blood procure an issue to the fullness thereof about the nose, or what is collected about the anus, there will be an abscess, or pains in the hypochondrium, or testicles, or in the limbs; and when these are resolved, there will be a discharge of thick sputa, and of smooth, thin urine. In fever attended with singultus, give asafoetida, oxymel, and carrot, triturated together, in a draught; or galbanum in honey, and cumin in a linctus, or the juice of ptisan. Such a person cannot escape, unless critical sweats and gentle sleep supervene, and thick and acrid urine be passed, or the disease terminate in an abscess: give pine-fruit and myrrh in a linctus, and further give a very little oxymel to drink; but if they are very thirsty, some barley-water.
11. Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common, in such a case, the physician should proceed thus: if the pain pass upward to the clavicle, or the breast, or the arm, the inner vein in the arm should be opened on the side affected, and blood abstracted according to the habit, age, and color of the patient, and the season of the year, and that largely and boldly, if the pain be acute, so as to bring on deliquium animi, and afterwards a clyster is to be given. But if the pain be below the chest, and if very intense, purge the bowels gently in such an attack of pleurisy, and during the act of purging give nothing; but after the purging give oxymel. The medicine is to be administered on the fourth day; on the first three days after the commencement, a clyster should be given, and if it does not relieve the patient, he should then be gently purged, but he is to be watched until the fever goes off, and till the seventh day; then if he appear to be free from danger, give him some unstrained ptisan, in small quantity, and thin at first, mixing it with honey. If the expectoration be easy, and the breathing free, if his sides be free of pain, and if the fever be gone, he may take the ptisan thicker, and in larger quantity, twice a day. But if he do not progress favorably, he must get less of the drink, and of the draught, which should be thin, and only given once a day, at whatever is judged to be the most favorable hour; this you will ascertain from the urine. The draught is not to be given to persons after fever, until you see that the urine and sputa are concocted (if, indeed, after the administration of the medicine he be purged frequently, it may be necessary to give it, but it should be given in smaller quantities and thinner than usual, for from inanition he will be unable to sleep, or digest properly, or wait the crisis); but when the melting down of crude matters has taken place, and his system has cast off what is offensive, there will then be no objection. The sputa are concocted when they resemble pus, and the urine when it has reddish sediments like tares. But there is nothing to prevent fomentations and cerates being applied for the other pains of the sides; and the legs and loins may be rubbed with hot oil, or anointed with fat; linseed, too, in the form of a cataplasm, may be applied to the hypochondrium and as far up as the breasts. When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand, unless there be a copious evacuation of thick urine, and the sputa be concocted; when either of these come on spontaneously, that will carry off the disease. A linctus for pneumonia: Galbanum and pine-fruit in Attic honey; and southernwood in oxymel; make a decoction of pepper and black hellebore, and give it in cases of pleurisy attended with violent pain at the commencement. It is also a good thing to boil opoponax in oxymel, and, having strained it, to give it to drink; it answers well, also, in diseases of the liver, and in severe pains proceeding from the diaphragm, and in all cases in which it is beneficial to determine to the bowels or urinary organs, when given in wine and honey; when given to act upon the bowels, it should be drunk in larger quantity, along with a watery hydromel.
12. A dysentery, when stopped, will give rise to an aposteme, or tumor, if it do not terminate in fevers with sweats, or with thick and white urine, or in a tertian fever, or the pain fix upon a varix, or the testicles, or on the hip-joints.
Translated by Charles Darwin Adams
1. Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces (for they are not at all alike, but differ much from themselves in regard to their changes). Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality. We must also consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities. In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how it lies as to the winds and the rising of the sun; for its influence is not the same whether it lies to the north or the south, to the rising or to the setting sun. These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.
2. From these things he must proceed to investigate everything else. For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters. And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen. For knowing the changes of the seasons, the risings and settings of the stars, how each of them takes place, he will be able to know beforehand what sort of a year is going to ensue. Having made these investigations, and knowing beforehand the seasons, such a one must be acquainted with each particular, and must succeed in the preservation of health, and be by no means unsuccessful in the practice of his art. And if it shall be thought that these things belong rather to meteorology, it will be admitted, on second thoughts, that astronomy contributes not a little, but a very great deal, indeed, to medicine. For with the seasons the digestive organs of men undergo a change.
3. But how of the aforementioned things should be investigated and explained, I will now declare in a clear manner. A city that is exposed to hot winds (these are between the wintry rising, and the wintry setting of the sun), and to which these are peculiar, but which is sheltered from the north winds; in such a city the waters will be plenteous and saltish, and as they run from an elevated source, they are necessarily hot in summer, and cold in winter; the heads of the inhabitants are of a humid and pituitous constitution, and their bellies subject to frequent disorders, owing to the phlegm running down from the head; the forms of their bodies, for the most part, are rather flabby; they do not eat nor drink much; drinking wine in particular, and more especially if carried to intoxication, is oppressive to them; and the following diseases are peculiar to the district: in the first place, the women are sickly and subject to excessive menstrua- tion; then many are unfruitful from disease, and not from nature, and they have frequent miscarriages; infants are subject to attacks of convulsions and asthma, which they consider to be connected with infancy, and hold to be a sacred disease (epilepsy). The men are subject to attacks of dysentery, diarrhea, hepialus, chronic fevers in winter, of epinyctis, frequently, and of hemorrhoids about the anus. Pleurisies, peripneumonies, ardent fevers, and whatever diseases are reckoned acute, do not often occur, for such diseases are not apt to prevail where the bowels are loose. Ophthalmies occur of a humid character, but not of a serious nature, and of short duration, unless they attack epidemically from the change of the seasons. And when they pass their fiftieth year, defluxions supervening from the brain, render them paralytic when exposed suddenly to strokes of the sun, or to cold. These diseases are endemic to them, and, moreover, if any epidemic disease connected with the change of the seasons, prevail, they are also liable to it.
4. But the following is the condition of cities which have the opposite exposure, namely, to cold winds, between the summer settings and the summer risings of the sun, and to which these winds are peculiar, and which are sheltered from the south and the hot breezes. In the first place the waters are, for the most part, hard cold. The men must necessarily be well braced and slender, and they must have the discharges downwards of the alimentary canal hard, and of difficult evacuation, while those upwards are more fluid, and rather bilious than pituitous. Their heads are sound and hard, and they are liable to burstings (of vessels?) for the most part. The diseases which prevail epidemically with them, are pleurisies, and those which are called acute diseases. This must be the case when the bowels are bound; and from any causes, many become affected with suppurations in the lungs, the cause of which is the tension of the body, and hardness of the bowels; for their dryness and the coldness of the water dispose them to ruptures (of vessels?). Such constitutions must be given to excess of eating, but not of drinking; for it is not possible to be gourmands and drunkards at the same time. Ophthalmies, too, at length supervene; these being of a hard and violent nature, and soon ending in rupture of the eyes; persons under thirty years of age are liable to severe bleedings at the nose in summer; attacks of epilepsy are rare but severe. Such people are likely to be rather long-lived; their ulcers are not attended with serious discharges, nor of a malignant character; in disposition they are rather ferocious than gentle. The diseases I have mentioned are peculiar to the men, and besides they are liable to any common complaint which may be prevailing from the changes of the seasons. But the women, in the first place, are of a hard constitution, from the waters being hard, indigestible, and cold; and their menstrual discharges are not regular, but in small quantity, and painful. Then they have difficult parturition, but are not very subject to abortions. And when they do bring forth children, they are unable to nurse them; for the hardness and indigestable nature of the water puts away their milk. Phthisis frequently supervenes after childbirth, for the efforts of it frequently bring on ruptures and strains. Children while still little are subject to dropsies in the testicle, which disappear as they grow older; in such a town they are late in attaining manhood. It is, as I have now stated, with regard to hot and cold winds and cities thus exposed.
5. Cities that are exposed to winds between the summer and the winter risings of the sun, and those the opposite to them, have the following characters:- Those which lie to the rising of the sun are all likely to be more healthy than such as are turned to the North, or those exposed to the hot winds, even if there should not be a furlong between them. In the first place, both the heat and cold are more moderate. Then such waters as flow to the rising sun, must necessarily be clear, fragrant, soft, and delightful to drink, in such a city. For the sun in rising and shining upon them purifies them, by dispelling the vapors which generally prevail in the morning. The persons of the inhabitants are, for the most part, well colored and blooming, unless some disease counteract. The inhabitants have clear voices, and in temper and intellect are superior to those which are exposed to the north, and all the productions of the country in like manner are better. A city so situated resembles the spring as to moderation between heat and cold, and the diseases are few in number, and of a feeble kind, and bear a resemblance to the diseases which prevail in regions exposed to hot winds. The women there are very prolific, and have easy deliveries. Thus it is with regard to them.
6. But such cities as lie to the west, and which are sheltered from winds blowing from the east, and which the hot winds and the cold winds of the north scarcely touch, must necessarily be in a very unhealthy situation: in the first place the waters are not clear, the cause of which is, because the mist prevails commonly in the morning, and it is mixed up with the water and destroys its clearness, for the sun does not shine upon the water until he be considerably raised above the horizon. And in summer, cold breezes from the east blow and dews fall; and in the latter part of the day the setting sun particularly scorches the inhabitants, and therefore they are pale and enfeebled, and are partly subject to all the aforesaid diseases, but no one is peculiar to them. Their voices are rough and hoarse owing to the state of the air, which in such a situation is generally impure and unwholesome, for they have not the northern winds to purify it; and these winds they have are of a very humid character, such being the nature of the evening breezes. Such a situation of a city bears a great resemblance to autumn as regards the changes of the day, inasmuch as the difference between morning and evening is great. So it is with regard to the winds that are conducive to health, or the contrary.
7. And I wish to give an account of the other kinds of waters, namely, of such as are wholesome and such as are unwholesome, and what bad and what good effects may be derived from water; for water contributes much towards health. Such waters then as are marshy, stagnant, and belong to lakes, are necessarily hot in summer, thick, and have a strong smell, since they have no current; but being constantly supplied by rain-water, and the sun heating them, they necessarily want their proper color, are unwholesome and form bile; in winter, they become congealed, cold, and muddy with the snow and ice, so that they are most apt to engender phlegm, and bring on hoarseness; those who drink them have large and obstructed spleens, their bellies are hard, emaciated, and hot; and their shoulders, collar-bones, and faces are emaciated; for their flesh is melted down and taken up by the spleen, and hence they are slender; such persons then are voracious and thirsty; their bellies are very dry both above and below, so that they require the strongest medicines. This disease is habitual to them both in summer and in winter, and in addition they are very subject to dropsies of a most fatal character; and in summer dysenteries, diarrheas, and protracted quartan fevers frequently seize them, and these diseases when prolonged dispose such constitutions to dropsies, and thus prove fatal. These are the diseases which attack them in summer; but in winter younger persons are liable to pneumonia, and maniacal affections; and older persons to ardent fevers, from hardness of the belly. Women are subject to oedema and leucophlegmasiae; when pregnant they have difficult deliveries; their infants are large and swelled, and then during nursing they become wasted and sickly, and the lochial discharge after parturition does not proceed properly with the women. The children are particularly subject to hernia, and adults to varices and ulcers on their legs, so that persons with such constitutions cannot be long-lived, but before the usual period they fall into a state of premature old age. And further, the women appear to be with child, and when the time of parturition arrives, the fulness of the belly disappears, and this happens from dropsy of the uterus. Such waters then I reckon bad for every purpose. The next to them in badness are those which have their fountains in rocks, so that they must necessarily be hard, or come from a soil which produces thermal waters, such as those having iron, copper, silver, gold, sulphur, alum, bitumen, or nitre (soda) in them; for all these are formed by the force of heat. Good waters cannot proceed from such a soil, but those that are hard and of a heating nature, difficult to pass by urine, and of difficult evacuation by the bowels. The best are those which flow from elevated grounds, and hills of earth; these are sweet, clear, and can bear a little wine; they are hot in summer and cold in winter, for such necessarily must be the waters from deep wells. But those are most to be commended which run to the rising of the sun, and especially to the summer sun; for such are necessarily more clear, fragrant, and light. But all such as are salty, crude, and harsh, are not good for drink. But there are certain constitutions and diseases with which such waters agree when drunk, as I will explain presently. Their characters are as follows: the best are such as have their fountains to the east; the next, those between the summer risings and settings of the sun, and especially those to the risings; and third, those between the summer and winter settings; but the worst are those to the south, and the parts between the winter rising and setting, and those to the south are very bad, but those to the north are better. They are to be used as follows: whoever is in good health and strength need not mind, but may always drink whatever is at hand. But whoever wishes to drink the most suitable for any disease, may accomplish his purpose by attending to the following directions: To persons whose bellies are hard and easily burnt up, the sweetest, the lightest, and the most limpid waters will be proper; but those persons whose bellies are soft, loose, and pituitous, should choose the hardest, those kinds that are most crude, and the saltiest, for thus will they be most readily dried up; for such waters as are adapted for boiling, and are of a very solvent nature, naturally loosen readily and melt down the bowels; but such as are intractable, hard, and by no means proper for boiling, these rather bind and dry up the bowels. People have deceived themselves with regard to salt waters, from inexperience, for they think these waters purgative, whereas they are the very reverse; for such waters are crude, and ill adapted for boiling, so that the belly is more likely to be bound up than loosened by them. And thus it is with regard to the waters of springs.
8. I will now tell how it is with respect to rain-water, and water from snow. Rain waters, then, are the lightest, the sweetest, the thinnest, and the clearest; for originally the sun raises and attracts the thinnest and lightest part of the water, as is obvious from the nature of salts; for the saltish part is left behind owing to its thickness and weight, and forms salts; but the sun attracts the thinnest part, owing to its lightness, and he abstracts this not only from the lakes, but also from the sea, and from all things which contain humidity, and there is humidity in everything; and from man himself the sun draws off the thinnest and lightest part of the juices. As a strong proof of this, when a man walks in the sun, or sits down having a garment on, whatever parts of the body the sun shines upon do not sweat, for the sun carries off whatever sweat makes its appearance; but those parts which are covered by the garment, or anything else, sweat, for the particles of sweat are drawn and forced out by the sun, and are preserved by the cover so as not to be dissipated by the sun; but when the person comes into the shade the whole body equally perspires, because the sun no longer shines upon it. Wherefore, of all kinds of water, these spoil the soonest; and rain water has a bad spot smell, because its particles are collected and mixed together from most objects, so as to spoil the soonest. And in addition to this, when attracted and raised up, being carried about and mixed with the air, whatever part of it is turbid and darkish is separated and removed from the other, and becomes cloud and mist, but the most attenuated and lightest part is left, and becomes sweet, being heated and concocted by the sun, for all other things when concocted become sweet. While dissipated then and not in a state of consistence it is carried aloft. But when collected and condensed by contrary winds, it falls down wherever it happens to be most condensed. For this is likely to happen when the clouds being carried along and moving with a wind which does not allow them to rest, suddenly encounters another wind and other clouds from the opposite direction: there it is first condensed, and what is behind is carried up to the spot, and thus it thickens, blackens, and is conglomerated, and by its weight it falls down and becomes rain. Such, to all appearance, are the best of waters, but they require to be boiled and strained; for otherwise they have a bad smell, and occasion hoarseness and thickness of the voice to those who drink them. Those from snow and ice are all bad, for when once congealed, they never again recover their former nature; for whatever is clear, light, and sweet in them, is separated and disappears; but the most turbid and weightiest part is left behind. You may ascertain this in the following manner: If in winter you will pour water by measure into a vessel and expose it to the open air until it is all frozen, and then on the following day bring it into a warm situation where the ice will thaw, if you will measure the water again when dissolved you will find it much less in quantity. This is a proof that the lightest and thinnest part is dissipated and dried up by the congelation, and not the heaviest and thickest, for that is impossible: wherefore I hold that waters from snow and ice, and those allied to them, are the worst of any for all purposes whatever. Such are the characters of rain-water, and those from ice and snow.
9. Men become affected with the stone, and are seized with diseases of the kidneys, strangury, sciatica, and become ruptured, when they drink all sorts of waters, and those from great rivers into which other rivulets run, or from a lake into which many streams of all sorts flow, and such as are brought from a considerable distance. For it is impossible that such waters can resemble one another, but one kind is sweet, another saltish and aluminous, and some flow from thermal springs; and these being all mixed up together disagree, and the strongest part always prevails; but the same kind is not always the strongest, but sometimes one and sometimes another, according to the winds, for the north wind imparts strength to this water, and the south to that, and so also with regard to the others. There must be deposits of mud and sand in the vessels from such waters, and the aforesaid diseases must be engendered by them when drunk, but why not to all I will now explain. When the bowels are loose and in a healthy state, and when the bladder is not hot, nor the neck of the bladder very contracted, all such persons pass water freely, and no concretion forms in the bladder; but those in whom the belly is hot, the bladder must be in the same condition; and when preternaturally heated, its neck becomes inflamed; and when these things happen, the bladder does not expel the urine, but raises its heat excessively. And the thinnest part of it is secreted, and the purest part is passed off in the form of urine, but the thickest and most turbid part is condensed and concreted, at first in small quantity, but afterwards in greater; for being rolled about in the urine, whatever is of a thick consistence it assimilates to itself, and thus it increases and becomes indurated. And when such persons make water, the stone forced down by the urine falls into the neck of the bladder and stops the urine, and occasions intense pain; so that calculous children rub their privy parts and tear at them, as supposing that the obstruction to the urine is situated there. As a proof that it is as I say, persons affected with calculus have very limpid urine, because the thickest and foulest part remains and is concreted. Thus it generally is in cases of calculus. It forms also in children from milk, when it is not wholesome, but very hot and bilious, for it heats the bowels and bladder, so that the urine being also heated undergoes the same change. And I hold that it is better to give children only the most diluted wine, for such will least burn up and dry the veins. Calculi do not form so readily in women, for in them the urethra is short and wide, so that in them the urine is easily expelled; neither do they rub the pudendum with their hands, nor handle the passage like males; for the urethra in women opens direct into the pudendum, which is not the case with men, neither in them is the urethra so wide, and they drink more than children do. Thus, or nearly so, is it with regard to them.
10. And respecting the seasons, one may judge whether the year will prove sickly or healthy from the following observations:- If the appearances connected with the rising and setting stars be as they should be; if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy. But if the winter be dry and northerly, and the spring showery and southerly, the summer will necessarily be of a febrile character, and give rise to ophthalmies and dysenteries. For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution. Dysenteries are also likely to occur to women and those of a very humid temperament. And if at the rising of the Dogstar rain and wintery storms supervene, and if the etesian winds blow, there is reason to hope that these diseases will cease, and that the autumn will be healthy; but if not, it is likely to be a fatal season to children and women, but least of all to old men; and that convalescents will pass into quartans, and from quartans into dropsies; but if the winter be southerly, showery and mild, but the spring northerly, dry, and of a wintry character, in the first place women who happen to be with child, and whose accouchement should take place in spring, are apt to miscarry; and such as bring forth, have feeble and sickly children, so that they either die presently or are tender, feeble, and sickly, if they live. Such is the case with the women. The others are subject to dysenteries and dry ophthalmies, and some have catarrhs beginning in the head and descending to the lungs. Men of a phlegmatic temperament are likely to have dysenteries; and women, also, from the humidity of their nature, the phlegm descending downwards from the brain; those who are bilious, too, have dry ophthalmies from the heat and dryness of their flesh; the aged, too, have catarrhs from their flabbiness and melting of the veins, so that some of them die suddenly and some become paralytic on the right side or the left. For when, the winter being southerly and the body hot, the blood and veins are not properly constringed; a spring that is northerly, dry, and cold, having come on, the brain when it should have been expanded and purged, by the coryza and hoarseness is then constringed and contracted, so that the summer and the heat occurring suddenly, and a change supervening, these diseases fall out. And such cities as lie well to the sun and winds, and use good waters, feel these changes less, but such as use marshy and pooly waters, and lie well both as regards the winds and the sun, these all feel it more. And if the summer be dry, those diseases soon cease, but if rainy, they are protracted; and there is danger of any sore that there is becoming phagedenic from any cause; and lienteries and dropsies supervene at the conclusion of diseases; for the bowels are not readily dried up. And if the summer be rainy and southerly, and next the autumn, the winter must, of necessity, be sickly, and ardent fevers are likely to attack those that are phlegmatic, and more elderly than forty years, and pleurisies and peripneumonies those that are bilious. But if the summer is parched and northerly, but the autumn rainy and southerly, headache and sphacelus of the brain are likely to occur; and in addition hoarseness, coryza, coughs, and in some cases, consumption. But if the season is northerly and without water, there being no rain, neither after the Dogstar nor Arcturus; this state agrees best with those who are naturally phlegmatic, with those who are of a humid temperament, and with women; but it is most inimical to the bilious; for they become much parched up, and ophthalmies of a dry nature supervene, fevers both acute and chronic, and in some cases melancholy; for the most humid and watery part of the bile being consumed, the thickest and most acrid portion is left, and of the blood likewise, when these diseases came upon them. But all these are beneficial to the phlegmatic, for they are thereby dried up, and reach winter not oppressed with humors, but with them dried up.
11. Whoever studies and observes these things may be able to foresee most of the effects which will result from the changes of the seasons; and one ought to be particularly guarded during the greatest changes of the seasons, and neither willingly give medicines, nor apply the cautery to the belly, nor make incisions there until ten or more days be past. Now, the greatest and most dangerous are the two solstices, and especially the summer, and also the two equinoxes, but especially the autumnal. One ought also to be guarded about the rising of the stars, especially of the Dogstar, then of Arcturus, and then the setting of the Pleiades; for diseases are especially apt to prove critical in those days, and some prove fatal, some pass off, and all others change to another form and another constitution. So it is with regard to them.
12. I wish to show, respecting Asia and Europe, how, in all respects, they differ from one another, and concerning the figure of the inhabitants, for they are different, and do not at all resemble one another. To treat of all would be a long story, but I will tell you how I think it is with regard to the greatest and most marked differences. I say, then, that Asia differs very much from Europe as to the nature of all things, both with regard to the productions of the earth and the inhabitants, for everything is produced much more beautiful and large in Asia; the country is milder, and the dispositions of the inhabitants also are more gentle and affectionate. The cause of this is the temperature of the seasons, because it lies in the middle of the risings of the sun towards the east, and removed from the cold (and heat), for nothing tends to growth and mildness so much as when the climate has no predominant quality, but a general equality of temperature prevails. It is not everywhere the same with regard to Asia, but such parts of the country as lie intermediate between the heat and the cold, are the best supplied with fruits and trees, and have the most genial climate, and enjoy the purest waters, both celestial and terrestrial. For neither are they much burnt up by the heat, nor dried up by the drought and want of rain, nor do they suffer from the cold; since they are well watered from abundant showers and snow, and the fruits of the season, as might be supposed, grow in abundance, both such as are raised from seed that has been sown, and such plants as the earth produces of its own accord, the fruits of which the inhabitants make use of, training them from their wild state and transplanting them to a suitable soil; the cattle also which are reared there are vigorous, particularly prolific, and bring up young of the fairest description; the inhabitants too, are well fed, most beautiful in shape, of large stature, and differ little from one another either as to figure or size; and the country itself, both as regards its constitution and mildness of the seasons, may be said to bear a close resemblance to the spring. Manly courage, endurance of suffering, laborious enterprise, and high spirit, could not be produced in such a state of things either among the native inhabitants or those of a different country, for there pleasure necessarily reigns. For this reason, also, the forms of wild beasts there are much varied. Thus it is, as I think, with the Egyptians and Libyans.
13. But concerning those on the right hand of the summer risings of the sun as far as the Palus Maeotis (for this is the boundary of Europe and Asia), it is with them as follows: the inhabitants there differ far more from one another than those I have treated of above, owing to the differences of the seasons and the nature of the soil. But with regard to the country itself, matters are the same there as among all other men; for where the seasons undergo the greatest and most rapid changes, there the country is the wildest and most unequal; and you will find the greatest variety of mountains, forests, plains, and meadows; but where the seasons do not change much there the country is the most even; and, if one will consider it, so is it also with regard to the inhabitants; for the nature of some is like to a country covered with trees and well watered; of some, to a thin soil deficient in water; of others, to fenny and marshy places; and of some again, to a plain of bare and parched land. For the seasons which modify their natural frame of body are varied, and the greater the varieties of them the greater also will be the differences of their shapes.
14. I will pass over the smaller differences among the nations, but will now treat of such as are great either from nature, or custom; and, first, concerning the Macrocephali. There is no other race of men which have heads in the least resembling theirs. At first, usage was the principal cause of the length of their head, but now nature cooperates with usage. They think those the most noble who have the longest heads. It is thus with regard to the usage: immediately after the child is born, and while its head is still tender, they fashion it with their hands, and constrain it to assume a lengthened shape by applying bandages and other suitable contrivances whereby the spherical form of the head is destroyed, and it is made to increase in length. Thus, at first, usage operated, so that this constitution was the result of force: but, in the course of time, it was formed naturally; so that usage had nothing to do with it; for the semen comes from all parts of the body, sound from the sound parts, and unhealthy from the unhealthy parts. If, then, children with bald heads are born to parents with bald heads; and children with blue eves to parents who have blue eyes; and if the children of parents having distorted eyes squint also for the most part; and if the same may be said of other forms of the body, what is to prevent it from happening that a child with a long head should be produced by a parent having a long head? But now these things do not happen as they did formerly, for the custom no longer prevails owing to their intercourse with other men. Thus it appears to me to be with regard to them.
15. As to the inhabitants of Phasis, their country is fenny, warm, humid, and wooded; copious and severe rains occur there at all seasons; and the life of the inhabitants is spent among the fens; for their dwellings are constructed of wood and reeds, and are erected amidst the waters; they seldom practice walking either to the city or the market, but sail about, up and down, in canoes constructed out of single trees, for there are many canals there. They drink the hot and stagnant waters, both when rendered putrid by the sun, and when swollen with rains. The Phasis itself is the most stagnant of all rivers, and runs the smoothest; all the fruits which spring there are unwholesome, feeble and imperfect growth, owing to the redundance of water, and on this account they do not ripen, for much vapor from the waters overspreads the country. For these reasons the Phasians have shapes different from those of all other men; for they are large in stature, and of a very gross habit of body, so that not a joint nor vein is visible; in color they are sallow, as if affected with jaundice. Of all men they have the roughest voices, from their breathing an atmosphere which is not clear, but misty and humid; they are naturally rather languid in supporting bodily fatigue. The seasons undergo but little change either as to heat or cold; their winds for the most part are southerly, with the exception of one peculiar to the country, which sometimes blows strong, is violent and hot, and is called by them the wind cenchron. The north wind scarcely reaches them, and when it does blow it is weak and gentle. Thus it is with regard to the different nature and shape of the inhabitants of Asia and Europe.
16. And with regard to the pusillanimity and cowardice of the inhabitants, the principal reason the Asiatics are more unwarlike and of gentler disposition than the Europeans is, the nature of the seasons, which do not undergo any great changes either to heat or cold, or the like; for there is neither excitement of the understanding nor any strong change of the body whereby the temper might be ruffled and they be roused to inconsiderate emotion and passion, rather than living as they do always in the state. It is changes of all kinds which arouse understanding of mankind, and do not allow them to get into a torpid condition. For these reasons, it appears to me, the Asiatic race is feeble, and further, owing to their laws; for monarchy prevails in the greater part of Asia, and where men are not their own masters nor independent, but are the slaves of others, it is not a matter of consideration with them how they may acquire military discipline, but how they may seem not to be warlike, for the dangers are not equally shared, since they must serve as soldiers, perhaps endure fatigue, and die for their masters, far from their children, their wives, and other friends; and whatever noble and manly actions they may perform lead only to the aggrandizement of their masters, whilst the fruits which they reap are dangers and death; and, in addition to all this, the lands of such persons must be laid waste by the enemy and want of culture. Thus, then, if any one be naturally warlike and courageous, his disposition will be changed by the institutions. As a strong proof of all this, such Greeks or barbarians in Asia as are not under a despotic form of government, but are independent, and enjoy the fruits of their own labors, are of all others the most warlike; for these encounter dangers on their own account, bear the prizes of their own valor, and in like manner endure the punishment of their own cowardice. And you will find the Asiatics differing from one another, for some are better and others more dastardly; of these differences, as I stated before, the changes of the seasons are the cause. Thus it is with Asia.
17. In Europe there is a Scythian race, called Sauromatae, which inhabits the confines of the Palus Maeotis, and is different from all other races. Their women mount on horseback, use the bow, and throw the javelin from their horses, and fight with their enemies as long as they are virgins; and they do not lay aside their virginity until they kill three of their enemies, nor have any connection with men until they perform the sacrifices according to law. Whoever takes to herself a husband, gives up riding on horseback unless the necessity of a general expedition obliges her. They have no right breast; for while still of a tender age their mothers heat strongly a copper instrument constructed for this very purpose, and apply it to the right breast, which is burnt up, and its development being arrested, all the strength and fullness are determined to the right shoulder and arm.
18. As the other Scythians have a peculiarity of shape, and do not resemble any other, the same observation applies to the Egyptians, only that the latter are oppressed by heat and the former by cold. What is called the Scythian desert is a prairie, rich in meadows, high-lying, and well watered; for the rivers which carry off the water from the plains are large. There live those Scythians which are called Nomades, because they have no houses, but live in wagons. The smallest of these wagons have four wheels, but some have six; they are covered in with felt, and they are constructed in the manner of houses, some having but a single apartment, and some three; they are proof against rain, snow, and winds. The wagons are drawn by yokes of oxen, some of two and others of three, and all without horns, for they have no horns, owing to the cold. In these wagons the women live, but the men are carried about on horses, and the sheep, oxen, and horses accompany them; and they remain on any spot as long as there is provender for their cattle, and when that fails they migrate to some other place. They eat boiled meat, and drink the milk of mares, and also eat hippace, which is cheese prepared from the milk of the mare. Such is their mode of life and their customs.
19. In respect of the seasons and figure of body, the Scythian race, like the Egyptian, have a uniformity of resemblance, different from all other nations; they are by no means prolific, and the wild beasts which are indigenous there are small in size and few in number, for the country lies under the Northern Bears, and the Rhiphaean mountains, whence the north wind blows; the sun comes very near to them only when in the summer solstice, and warms them but for a short period, and not strongly; and the winds blowing from the hot regions of the earth do not reach them, or but seldom, and with little force; but the winds from the north always blow, congealed, as they are, by the snow, ice, and much water, for these never leave the mountains, which are thereby rendered uninhabitable. A thick fog covers the plains during the day, and amidst it they live, so that winter may be said to be always present with them; or, if they have summer, it is only for a few days, and the heat is not very strong. Their plains are high-lying and naked, not crowned with mountains, but extending upwards under the Northern Bears. The wild beasts there are not large, but such as can be sheltered underground; for the cold of winter and the barrenness of the country prevent their growth, and because they have no covert nor shelter. The changes of the seasons, too, are not great nor violent, for, in fact, they change gradually; and therefore their figures resemble one another, as they all equally use the same food, and the same clothing summer and winter, respiring a humid and dense atmosphere, and drinking water from snow and ice; neither do they make any laborious exertions, for neither body nor mind is capable of enduring fatigue when the changes of the seasons are not great. For these reasons their shapes are gross and fleshy, with ill-marked joints, of a humid temperament, and deficient in tone: the internal cavities, and especially those of the intestines, are full of humors; for the belly cannot possibly be dry in such a country, with such a constitution and in such a climate; but owing to their fat, and the absence of hairs from their bodies, their shapes resemble one another, the males being all alike, and so also with the women; for the seasons being of a uniform temperature, no corruption or deterioration takes place in the concretion of the semen, unless from some violent cause, or from disease.
20. I Will give you a strong proof of the humidity (laxity?) of their constitutions. You will find the greater part of the Scythians, and all the Nomades, with marks of the cautery on their shoulders, arms, wrists, breasts, hip-joints, and loins, and that for no other reason but the humidity and flabbiness of their constitution, for they can neither strain with their bows, nor launch the javelin from their shoulder owing to their humidity and atony: but when they are burnt, much of the humidity in their joints is dried up, and they become better braced, better fed, and their joints get into a more suitable condition. They are flabby and squat at first, because, as in Egypt, they are not swathed (?); and then they pay no attention to horsemanship, so that they may be adepts at it; and because of their sedentary mode of life; for the males, when they cannot be carried about on horseback, sit the most of their time in the wagon, and rarely practise walking, because of their frequent migrations and shiftings of situation; and as to the women, it is amazing how flabby and sluggish they are. The Scythian race are tawny from the cold, and not from the intense heat of the sun, for the whiteness of the skin is parched by the cold, and becomes tawny.
21. It is impossible that persons of such a constitution could be prolific, for, with the man, the sexual desires are not strong, owing to the laxity of his constitution, the softness and coldness of his belly, from all which causes it is little likely that a man should be given to venery; and besides, from being jaded by exercise on horseback, the men become weak in their desires. On the part of the men these are the causes; but on that of the women, they are embonpoint and humidity; for the womb cannot take in the semen, nor is the menstrual discharge such as it should be, but scanty and at too long intervals; and the mouth of the womb is shut up by fat and does not admit the semen; and, moreover, they themselves are indolent and fat, and their bellies cold and soft. From these causes the Scythian race is not prolific. Their female servants furnish a strong proof of this; for they no sooner have connection with a man than they prove with child, owing to their active course of life and the slenderness of body.
22. And, in addition to these, there are many eunuchs among the Scythians, who perform female work, and speak like women. Such persons are called effeminates. The inhabitants of the country attribute the cause of their impotence to a god, and venerate and worship such persons, every one dreading that the like might befall himself; but to me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another, but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause. But I will explain how I think that the affection takes its rise. From continued exercise on horseback they are seized with chronic defluxions in their joints owing to their legs always hanging down below their horses; they afterwards become lame and stiff at the hip-joint, such of them, at least, as are severely attacked with it. They treat themselves in this way: when the disease is commencing, they open the vein behind either ear, and when the blood flows, sleep, from feebleness, seizes them, and afterwards they awaken, some in good health and others not. To me it appears that the semen is altered by this treatment, for there are veins behind the ears which, if cut, induce impotence; now, these veins would appear to me to be cut. Such persons afterwards, when they go in to women and cannot have connection with them, at first do not think much about it, but remain quiet; but when, after making the attempt two, three, or more times, they succeed no better, fancying they have committed some offence against the god whom they blame for the affection, they put on female attire, reproach themselves for effeminacy, play the part of women, and perform the same work as women do. This the rich among the Scythians endure, not the basest, but the most noble and powerful, owing to their riding on horseback; for the poor are less affected, as they do not ride on horses. And yet, if this disease had been more divine than the others, it ought not to have befallen the most noble and the richest of the Scythians alone, but all alike, or rather those who have little, as not being able to pay honors to the gods, if, indeed, they delight in being thus rewarded by men, and grant favors in return; for it is likely that the rich sacrifice more to the gods, and dedicate more votive offerings, inasmuch as they have wealth, and worship the gods; whereas the poor, from want, do less in this way, and, moreover, upbraid the gods for not giving them wealth, so that those who have few possessions were more likely to bear the punishments of these offences than the rich. But, as I formerly said, these affections are divine just as much as others, for each springs from a natural cause, and this disease arises among the Scythians from such a cause as I have stated. But it attacks other men in like manner, for whenever men ride much and very frequently on horseback, then many are affected with rheums in the joints, sciatica, and gout, and they are inept at venery. But these complaints befall the Scythians, and they are the most impotent of men for the aforesaid causes, and because they always wear breeches, and spend the most of their time on horseback, so as not to touch their privy parts with the hands, and from the cold and fatigue they forget the sexual desire, and do not make the attempt until after they have lost their virility. Thus it is with the race of the Scythians.
23. The other races in Europe differ from one another, both as to stature and shape, owing to the changes of the seasons, which are very great and frequent, and because the heat is strong, the winters severe, and there are frequent rains, and again protracted droughts, and winds, from which many and diversified changes are induced. These changes are likely to have an effect upon generation in the coagulation of the semen, as this process cannot be the same in summer as in winter, nor in rainy as in dry weather; wherefore, I think, that the figures of Europeans differ more than those of Asiatics; and they differ very much from one another as to stature in the same city; for vitiations of the semen occur in its coagulation more frequently during frequent changes of the seasons, than where they are alike and equable. And the same may be said of their dispositions, for the wild, and unsociable, and the passionate occur in such a constitution; for frequent excitement of the mind induces wildness, and extinguishes sociableness and mildness of disposition, and therefore I think the inhabitants of Europe more courageous than those of Asia; for a climate which is always the same induces indolence, but a changeable climate, laborious exertions both of body and mind; and from rest and indolence cowardice is engendered, and from laborious exertions and pains, courage. On this account the inhabitants of Europe are than the Asiatics, and also owing to their institutions, because they are not governed by kings like the latter, for where men are governed by kings there they must be very cowardly, as I have stated before; for their souls are enslaved, and they will not willingly, or readily undergo dangers in order to promote the power of another; but those that are free undertake dangers on their own account, and not for the sake of others; they court hazard and go out to meet it, for they themselves bear off the rewards of victory, and thus their institutions contribute not a little to their courage. Such is the general character of Europe and Asia.
24. And there are in Europe other tribes, differing from one another in stature, shape, and courage: the differences are those I formerly mentioned, and will now explain more clearly. Such as inhabit a country which is mountainous, rugged, elevated, and well watered, and where the changes of the seasons are very great, are likely to have great variety of shapes among them, and to be naturally of an enterprising and warlike disposition; and such persons are apt to have no little of the savage and ferocious in their nature; but such as dwell in places which are low-lying, abounding in meadows and ill ventilated, and who have a larger proportion of hot than of cold winds, and who make use of warm waters- these are not likely to be of large stature nor well proportioned, but are of a broad make, fleshy, and have black hair; and they are rather of a dark than of a light complexion, and are less likely to be phlegmatic than bilious; courage and laborious enterprise are not naturally in them, but may be engendered in them by means of their institutions. And if there be rivers in the country which carry off the stagnant and rain water from it, these may be wholesome and clear; but if there be no rivers, but the inhabitants drink the waters of fountains, and such as are stagnant and marshy, they must necessarily have prominent bellies and enlarged spleens. But such as inhabit a high country, and one that is level, windy, and well-watered, will be large of stature, and like to one another; but their minds will be rather unmanly and gentle. Those who live on thin, ill-watered, and bare soils, and not well attempered in the changes of the seasons, in such a country they are likely to be in their persons rather hard and well braced, rather of a blond than a dark complexion, and in disposition and passions haughty and self-willed. For, where the changes of the seasons are most frequent, and where they differ most from one another, there you will find their forms, dispositions, and nature the most varied. These are the strongest of the natural causes of difference, and next the country in which one lives, and the waters; for, in general, you will find the forms and dispositions of mankind to correspond with the nature of the country; for where the land is fertile, soft, and well-watered, and supplied with waters from very elevated situations, so as to be hot in summer and cold in winter, and where the seasons are fine, there the men are fleshy, have ill-formed joints, and are of a humid temperament; they are not disposed to endure labor, and, for the most part, are base in spirit; indolence and sluggishness are visible in them, and to the arts they are dull, and not clever nor acute. When the country is bare, not fenced, and rugged, blasted by the winter and scorched by the sun, there you may see the men hardy, slender, with well-shaped joints, well-braced, and shaggy; sharp industry and vigilance accompany such a constitution; in morals and passions they are haughty and opinionative, inclining rather to the fierce than to the mild; and you will find them acute and ingenious as regards the arts, and excelling in military affairs; and likewise all the other productions of the earth corresponding to the earth itself. Thus it is with regard to the most opposite natures and shapes; drawing conclusions from them, you may judge of the rest without any risk of error.